Should medicine be an entitlement?

[MajorBubblez]

And yet they still make six figure incomes. Do you not see how that's not the same as being held hostage and forced to work for free?

This is almost completely irrelevant.

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[deleted480308]

And yet they still make six figure incomes. Do you not see how that's not the same as being held hostage and forced to work for free?

so the man who is held captive for 4 months should be thankful he wasn't held for a year?...

 

[CircadianRhythm]

False equivalence fallacy: False equivalence is a logical fallacy which describes a situation where there is a logical and apparent equivalence, but when in fact there is none. A common way for this fallacy to be perpetuated is one shared trait between two subjects is assumed to show equivalence, especially in order of magnitude, when equivalence is not necessarily the logical result. False equivalence is a common result when an anecdotal similarity is pointed out as equal, but the claim of equivalence doesn't bear because the similarity is based on oversimplification or ignorance of additional factors.

And yet they still make six figure incomes. Do you not see how that's not the same as being held hostage and forced to work for free?

so the man who is held captive for 4 months should be thankful he wasn't held for a year?...

....

 

[deleted480308]

False equivalence fallacy: False equivalence is a logical fallacy which describes a situation where there is a logical and apparent equivalence, but when in fact there is none. A common way for this fallacy to be perpetuated is one shared trait between two subjects is assumed to show equivalence, especially in order of magnitude, when equivalence is not necessarily the logical result. False equivalence is a common result when an anecdotal similarity is pointed out as equal, but the claim of equivalence doesn't bear because the similarity is based on oversimplification or ignorance of additional factors.

....

don't be obtuse, if I work for a year and only get paid for 8 months I have been wronged. You can call it theft of wages or enslaving me for labor but you are taking without paying.

 

[Entadus]

Says the person who jumped into a thread about healthcare ethics and started spouting crazy organic hippy nonsense. Your post is off topic, that's why I gave it the reaction it did.

You say that like being a hippy is a bad thing

Keep eating your Tyson bacon everyday

 

[SpinalFusion]

Hey OP. I always love the tough questions, and I'll apologize beforehand if my comments offend...

In my opinion though, the right to life is the right to not be killed on the whim of some tyrant. Whether that tyrant be some thug dealing drugs or an 18th century Englishman, your life belongs to you and you alone. You accept the responsibility for your life, and enjoy the promise that it won't be taken away from you.
Just like with our right to bear arms or our right to liberty or the pursuit of happiness, The opportunity is provided if you take the responsibility to procure it for yourself. Rights are doors that are open (or at least unlocked), it is completely our responsibility to walk through them. The promise of a right is simply the promise that these doors will not be unjustly closed off to us by the actions of others.

So in providing medicine, I would say I have a Professional Responsibility to provide the absolute best care possible to my patients. But according to my definition, I am in no way the provider nor the insurer of my patients right to Life. I am not responsible for their lives. Instead I voluntarily enter a contract to provide a service that the patient has requested. The patient requesting my services is the patient taking responsibility for their life.

 

[CircadianRhythm]

I would call it theft of wages and not enslaving you. Do you know what being enslaved means? The flippant way in which you use it to describe some of the top earning professionals suggests that you do not.

 

[deleted480308]

I would call it theft of wages and not enslaving you. Do you know what being enslaved means? The flippant way in which you use it to describe some of the top earning professionals suggests that you do not.

so you admit it's theft of wages now?

 

[Mad Jack]

You say that like being a hippy is a bad thing

Keep eating your Tyson bacon everyday

I buy my bacon from a local butcher, personally.

 

[Entadus]

I buy my bacon from a local butcher, personally.

Then you're helping to illustrate Lifebloom's earlier point. Not everyone can afford to do so. The inability of the poor of this country to buy healthy foods is a legitimate health issue. Plus, I still must protest your use of "hippy" as some kind of bad word. This planet could use a few more hippies.

 

[MajorBubblez]

Then you're helping to prove Lifebloom's earlier point. Not everyone can afford to do so. The inability of the poor of this country to buy healthy foods is a legitimate health issue. Plus, I still must protest your use of "hippy" as some kind of bad word. This planet could use a few more hippies.

I'm not sure bacon qualifies as healthy food...

 

[Entadus]

I'm not sure bacon qualifies as healthy food...

Touche!

 

[CircadianRhythm]

I never said physicians cannot be victims of theft of wages. It depends entirely on the circumstance.

 

[dpmd]

Also I'm really curious how @jdh71 @dpmd or @Winged Scapula would answer this question

I believe that all humans should be able to seek out care when they are ill or injured. I don't believe they are entitled to any specific kinds of care or to an outcome of "health". I have personally treated perpetrators of crime and other people generally considered "bad" and I provide them care to the best of my ability with the resources I have at my disposal just as I do for any patient I treat. Sometimes that means they don't get the same thing they would have gotten at a better funded hospital (back when i was at the county hospital) they don't get the specialty care I would have preferred but I don't make that decision based on their personal characteristics. I don't even really make it based on their ability to pay because I will try for the transfer or specialist, then forces beyond my control make the decisions. I do work with patients who tell me about issues with paying and I try to find workable solutions although they won't come in to my clinic as a new patient unless they make some kind of pay arrangements because most of the care I provide involves other resources like a surgery center or hospital plus anesthesia so it would be a waste of time to see someone I won't be able to do anything for. If however they come in through the er, I see them regardless of insurance, whether the are a drug user or a prisoner, whether they are nice to me or jerks, and whether they are responsible for their problem or not. I can do this because the hospital decided it was worthwile to pay me to be on call and to pay me a certain percent of Medicare rates for people without insurance who are unable to pay their bills. This lets me not worry about whether I am going to do a lot of work for free (which I am ok with some but not a lot, I like helping people but I have to make a living too). I don't think that we need to have the government try to make the current healthcare budget work to cover everybody's every healthcare need as that would lead to the need for some pretty heavy rationing. I don't think we should raise taxes to increase the budget available to pay for everybody's every health care need because it would become ever more expensive and cripple us (because once you divorce the provision of care from the payment for care incentives lead to strange things, which we see in the ER utilization by medicaid patients even though they have coverage to be seen in a non-er setting and in them seeking out a medical provider for prescriptions of medications that can be obtained at the dollar store-occasionally preceeded by an ambulance ride). I would be in favor of covering the kinds of discussions that might lead to patients making choices that would lead to less money being spent at the end of life and using the cost savings to help people who can't afford care (in whatever fashion is most effective). Until we help people realize that their right to life doesn't mean they should seek to prolong life in all scenarios we are going to keep spending huge amounts for care that doesn't do much in the grand scheme of things. That is something that would make more of a difference than just picking certain categories of patients that we don't like and stop paying for their care

 

[GUH]

Wage theft isn't slavery the same way sharecropping isn't slavery.
Requiring somebody to perform work regardless of whether they want to or not is still slavery.

 

[Mad Jack]

Then you're helping to illustrate Lifebloom's earlier point. Not everyone can afford to do so. The inability of the poor of this country to buy healthy foods is a legitimate health issue. Plus, I still must protest your use of "hippy" as some kind of bad word. This planet could use a few more hippies.

Actually, I buy it from the butcher because it's cheaper. Name brand bacon costs 6-7 bucks when it's not on sale. Thick cut, local butcher bacon costs 4.50-4.99/lb.

I'm okay with hippies. I'm not okay with the organic hippie vegan science denying degenerates that seem to be swarming about everywhere in the Left lately.

 

[CircadianRhythm]

edit

 

[ERK123]

I'm not sure how that's a refutation to my claims.

My premise: If the government can no longer provide free and open elections then it is no longer a consolidated democratic republic, and no longer has the mandate to protect the rights of the people or provide the resources they are entitled to.


Of course it does. Let's imagine a hypothetical construct: the government has the resources to pay for one program. Its choices are between a program that would ensure free speech (let's assume it would otherwise be trampled) and a program that would fund social security. Which should it choose?

I would need more information about this hypothetical before I give my opinion

 

[jdh71]

Nope, our system does not require that everyone pay income tax, a solid half the country doesn't. Our system allows that half to live off the rest of us, it is theft

EVERYONE pays tax of some kind or another. If there is ONE thing the government hates its a pile of money somewhere that they don't have their grubby fingers in. Income tax is just one tax.

 

[ERK123]

our tax code already has physicians doing 30% of their work for free

Your ignoring sales tax

 

[CircadianRhythm]

Wage theft isn't slavery the same way sharecropping isn't slavery.
Requiring somebody to perform work regardless of whether they want to or not is still slavery.

Another false equivalency fallacy. Your ability to bend reality at will is commendable. Please explain to me how a AMG who is BE/BC in 2015 is equally as disenfranchised and has a comparable existence to a post civil war sharecropper.

Also there are no American physicians enslaved in any present or foreseeable system. The notion is offensive. You realize there are actual slaves in the world? And their life looks nothing like an American professional who makes 200 grand a year.

 

[ERK123]

so the man who is held captive for 4 months should be thankful he wasn't held for a year?...

He should be thankful that captivity still comes with access to cable, a nice car, a house, and the resources to go on vacation.

 

[dpmd]

The tldr version of my wall of text is we shouldn't flat out deny care just because we don't like people or what they do, but the money for the care people get is best coming out of their own pocket (either cash or through insurance), with charity being another good choice, and forced redistribution last on the list (but reasonable for real emergency stuff because it feels bad to just let people die)

 

[IlDestriero]

You can make medicine an entitlement for all citizens when you come up with a plan that will not bankrupt the government and hospital systems and still pay the providers fairly for their time and services. (Hint: not CHIP, Medicaid, etc.) If that plan involves taking over healthcare facilities, etc. have a look at the VA system. There are services that physicians provide that entail assuming risk, etc. that Medicare, etc pay nothing or almost nothing. What about the private physician that is forced to hire an interpreter for the deaf Medicaid patient that costs more than the fee he gets for the visit? These things are real problems. When your government pay ratio gets too high, you go bankrupt. Why are some children's hospitals growing and expanding and thriving while others are bankrupt and failing. Payer mix. It is not as simple as issuing everyone a Medicare card.
Good luck.

 

[dpmd]

Also, if we could save even a quarter of what medicare pays for care in the last few weeks of life we could do a lot of good things with that money and i bet we could do it without forcing anyone to go against their wishes so maybe that is a better strategy that killing junkies (or whatever "undesirable" that gets picked).

 

[IlDestriero]

Also, if we could save even a quarter of what medicare pays for care in the last few weeks of life we could do a lot of good things with that money and i bet we could do it without forcing anyone to go against their wishes so maybe that is a better strategy that killing junkies (or whatever "undesirable" that gets picked).

I volunteer to serve on the death panel. My answer will almost always be "No". Maybe "try it for 3 days" then comfort care time.
When I'm circling the drain, you can also vote "No." Please.

 

[Mad Jack]

Truth.

Although I will freely admit the cost of bacon is not something I give much thought to. I buy bacon maybe every other month at most? So the absolute price difference between buying whatever brand strikes my fancy and the bargain brand is like a ten dollar difference over the course of a year.

I buy all my meat from a local butcher. Everything is $1-2/lb lower than the **** you'd get in a grocery store, and the sales are glorious.

 

[Mad Jack]

Also, if we could save even a quarter of what medicare pays for care in the last few weeks of life we could do a lot of good things with that money and i bet we could do it without forcing anyone to go against their wishes so maybe that is a better strategy that killing junkies (or whatever "undesirable" that gets picked).

Dat logic

 

[Mad Jack]

I volunteer to serve on the death panel. My answer will almost always be "No". Maybe "try it for 3 days" then comfort care time.
When I'm circling the drain, you can also vote "No." Please.

I plan to have DNR/DNI tattoos after 55 myself. There will be no ambiguity with my wishes. I might even have a little tattoo that says how much I hate anyone that denies my wishes and how they're being denied any potential inheritance they might acquire by dragging out my miserable existence.

 

[dpmd]

I volunteer to serve on the death panel. My answer will almost always be "No". Maybe "try it for 3 days" then comfort care time.
When I'm circling the drain, you can also vote "No." Please.

I have yet to meet a person that said they wanted to spend their last day of life in the ICU with tubes coming out of every hole and getting their ribs broken while they lay naked with a crowd of people around. Yet I meet plenty of people with bad diagnoses who have never even had a discussion about when to change from prolonging life to maximizing quality. You know how much more money I get for the hour long conversation I often have with them when I get consulted (even if it is for some trivial unrelated issue they don't need a surgery for) versus the quick in and out visit to figure out the situation and bail? Not a single penny. I do it anyway because I am passionate about the issue, I usually have time, and I know there is a decent chance no one else will do it.

 

[Mad Jack]

I have yet to meet a person that said they wanted to spend their last day of life in the ICU with tubes coming out of every hole and getting their ribs broken while they lay naked with a crowd of people around. Yet I meet plenty of people with bad diagnoses who have never even had a discussion about when to change from prolonging life to maximizing quality. You know how much more money I get for the hour long conversation I often have with them when I get consulted (even if it is for some trivial unrelated issue they don't need a surgery for) versus the quick in and out visit to figure out the situation and bail? Not a single penny. I do it anyway because I am passionate about the issue, I usually have time, and I know there is a decent chance no one else will do it.

But is it safe?

 

[dpmd]

I plan to have DNR/DNI tattoos after 55 myself. There will be no ambiguity with my wishes. I might even have a little tattoo that says how much I hate anyone that denies my wishes and how they're being denied any potential inheritance they might acquire by dragging out my miserable existence.

Tattoos won't count. A medic alert bracelet might. I actually have my advance directive filled out already because young people get into end of life scenarios sometimes too (but I am not DNR/DNI right off the bat though).

 

[Mad Jack]

Tattoos won't count. A medic alert bracelet might. I actually have my advance directive filled out already because young people get into end of life scenarios sometimes too (but I am not DNR/DNI right off the bat though).

I'll obviously have a bracelet and paperwork. The tattoos will just be the final layer of reinforcement in case they miss everything else. If you put the left pad over "DNR" and the right over "DNI," you're just an ass.

 

[IlDestriero]

You can shock and not intubate. I've done that to pre op cardiac patients.

 

[LeftShark]

There should be zero entitlements. That being said, I would be okay with very minimal health services offered at taxpayer expense. Perhaps abolish medicaid/medicare and simply offer everyone free generic prescriptions, primary care visits, and limited catastrophic coverage. Unfortunately, I fear that this would just grow into a larger system eventually. The influence of welfare states overseas has unfortunately had a paralyzing effect on our healthcare policy. Some on the left refuse to accept anything that doesn't lead closer to universal healthcare, and some of the right refuse to accept anything that might lead to universal healthcare. Thus we're stuck with a system that is clearly wasteful, at least in terms of value received per government dollar spent.

 

[GUH]

Another false equivalency fallacy. Your ability to bend reality at will is commendable. Please explain to me how a AMG who is BE/BC in 2015 is equally as disenfranchised and has a comparable existence to a post civil war sharecropper.

Also there are no American physicians enslaved in any present or foreseeable system. The notion is offensive. You realize there are actual slaves in the world? And their life looks nothing like an American professional who makes 200 grand a year.

Whether a notion is offensive is irrelevant to its merit.
Many doctors don't make 200 grand per year, especially those who treat the very people you pretend to be so concerned about. So how about that for fallacy?
Let's ask a simple question - what would you suggest we do if doctors refuse to see patients at the rates provided for under your proposed system?

 

[group_theory]

I have yet to meet a person that said they wanted to spend their last day of life in the ICU with tubes coming out of every hole and getting their ribs broken while they lay naked with a crowd of people around. Yet I meet plenty of people with bad diagnoses who have never even had a discussion about when to change from prolonging life to maximizing quality. You know how much more money I get for the hour long conversation I often have with them when I get consulted (even if it is for some trivial unrelated issue they don't need a surgery for) versus the quick in and out visit to figure out the situation and bail? Not a single penny. I do it anyway because I am passionate about the issue, I usually have time, and I know there is a decent chance no one else will do it.

Depending on the situation and circumstances, you may be able to bill critical care time for that meeting.

Here's CMS's position on this
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
Look for section 30.6.12 titled Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 9 9292) (page 65), under Section E titled Critical Care Services and Physician Time (starting on page 68) where they discuss family counseling/discussions in Section E starting on page 69
*to save time/headache, I've quoted the relevant portion

Family Counseling/Discussions:

• Critical care CPT codes 99291 and 99292 include pre and post service work. Routine daily updates or reports to family members and or surrogates are considered part of this service. However, time involved with family members or other surrogate decision makers, whether to obtain a history or to discuss treatment options (as described in CPT), may be counted toward critical care time when these specific criteria are met:
  • The patient is unable or incompetent to participate in giving a history and/or making treatment decisions, and
  • The discussion is necessary for determining treatment decisions.
• For family discussions, the physician should document the following
  • The patient is unable or incompetent to participate in giving history and/or making treatment decisions.
  • The necessity to have the discussion (e.g., "no other source was available to obtain a history" or "because the patient was deteriorating so rapidly I needed to immediately discuss treatment options with the family"),
  • Medically necessary treatment decisions for which the discussion was needed, and
  • A summary in the medical record that supports the medical necessity of the discussion.
• All other family discussions, no matter how lengthy, may not be additionally counted towards critical care. Telephone calls to family members and or surrogate decision-makers may be counted towards critical care time, but only if they meet the same criteria as described in the aforementioned paragraph.

 

[dpmd]

Depending on the situation and circumstances, you may be able to bill critical care time for that meeting.

Here's CMS's position on this
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
Look for section 30.6.12 titled Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 9 9292) (page 65), under Section E titled Critical Care Services and Physician Time (starting on page 68) where they discuss family counseling/discussions in Section E starting on page 69
*to save time/headache, I've quoted the relevant portion

Except if I document well enough I can bill critical care time without taking that long

 

[loris]

Another example that the dean of our college actually brought up was that he was working as an ER doc and there was a school shooting. The victims and the shooter came into the ER. He treated both the victims and the shooter. You don't get to deny care because you disagree with something that person has done.

inb4 someone says I'm being disrespectful to people who shoot up schools.

*Unfortunately necessary disclaimer: I'm not posting this with the intent to launch a heated debate on whether individual physicians and facilities should perform/refuse to perform abortions or the morality of abortion itself, because those topics could potentially transform this thread into a complete ****storm; I’m just replying to TP's post with an example of judging patients.

In seven states, some medical facilities have been effectively declining to administer emergency treatment based on the perceived morality of patients’ life choices. Abortion providers in those states are legally required to have an emergency medical transfer agreement with a specific medical facility; a transfer agreement is just a formal contract stating that a hospital agrees to provide emergency medical treatment in the unlikely event that a patient obtaining an abortion has a serious complication. Since this is a service that hospitals normally provide in all medical emergencies, the transfer agreement is unnecessary and indirectly restricts a patient’s access to emergency treatment. Although technically they are not officially turning away patients, any medical facilities that decline to engage in a transfer agreement are effectively refusing to treat those potential patients, including any women whose complications may be the result of a legal, medically necessary abortion.

Less than 0.05% of first trimester abortions performed nationally result in complications that require hospitalization. The purported rationale behind requiring transfer agreements between clinics and hospitals is increased patient safety, but compared to several other medical procedures, abortion is fairly low risk, and effectively restricting which hospitals critically ill patients can be sent to may potentially increase the likelihood of a negative outcome or expense in the event of a complication.

In contrast to the other six states, all public hospitals in Ohio are legally banned from engaging in transfer agreements, because some people believe that allowing a public hospital to treat a critical patient with a serious complication from an abortion that was performed elsewhere by someone else is equivalent to directly funding abortions with taxpayer money. By that logic, the government is directly funding all circumstances and decisions that can lead to an ER visit, and should restrict all public hospitals from treating any patient whose condition is the result of a controversial personal choice or an illegal act. Would Ohioans consider it equally acceptable to ban public hospitals from treating smokers, alcoholics, the obese, prisoners, drug addicts, and anyone who killed or injured another human being or animal (murderers, drunk drivers, military veterans, police officers, farmers, etc.) either due to uncontrollable circumstances (accidents, etc.) or as a direct result of a personal choice (malicious, occupational, self-defense, etc.)?

Anyhow, transfer agreements are currently required by the following seven states. Really only a handful of patients experience complications, which to me makes it a little more ridiculous that a lot of hospitals won't just step up and agree to treat any potential emergency cases. In the statistics below, some procedures may have had more than one complication, so the listed total number of complications may be greater than the actual total number of procedures that had complications.

• Kentucky (Total abortions in 2011: 3,970; Total complications: not reported; Number of patient deaths: not reported)

• Michigan (Total abortions in 2013: 26,120; Total number of procedures with immediate complications: 13, * retained products of conception accounted for 3 of the reported complications; Number of patient deaths: 0)

• Nebraska (Total abortions in 2013: 2,177; Total complications: 0; Number of patient deaths: 0)

• Ohio (Total abortions in 2013: 23,216; Total complications according to one chart/reporting form: 13, * retained products of conception accounted for 1 of the reported 13 complications; Total complications according to a different chart/reporting form: 99, * retained products of conception accounted for 33 of the reported 99 complications; Number of patient deaths: 0)

• Pennsylvania (Total abortions in 2013: 32,108; Number of procedures with complications: 178, *retained products of conception accounted for 115 of the reported complications; Number of patient deaths: not reported)

• Virginia (Total abortions in 2011: 27,110; Total complications: not reported; Number of patient deaths: not reported)

• Wisconsin (Total abortions in 2013: 6,463; Total complications: 16, *retained products of conception accounted for 1 of the complications; Number of patient deaths: not reported)

• Texas (Total abortions in 2012: 68,298; Total complications: not reported; Number of patient deaths: 0) *Transfer agreement law is temporarily enjoined pending a final decision in the courts.

 

[GunnerBMS]

How can you call yourselves doctors and be against universal healthcare? Clearly most of you right wingers must have gone into medicine for the money.

 

[Stagg737]

I'll also add that there have been multiple studies which found that the vast majority of an individual's health expenditures in their lifetime occur in the last 3 weeks (something like 80% or 71k on average) and that 1 out of ever 4 medicare dollars (or over 125 billion) are spent on end of life care.

I think a huge part of this is that people don't know how to die or let their parents/loved ones go in our country. As @dpmd said, most people don't want to spend the last days of their lives in an ICU getting their ribs cracked with tubes down their throats, and a lot of studies have shown better outcomes, physically, financially, and emotionally, in many patients and their loved ones when they spend their final days/weeks/months with their loved ones than in a hospital wing. I really don't understand the mindset of keeping end of life patients in the hospitals when it would be so much more beneficial to everyone to not keep those patients there...

Hey OP. I always love the tough questions, and I'll apologize beforehand if my comments offend...

In my opinion though, the right to life is the right to not be killed on the whim of some tyrant. Whether that tyrant be some thug dealing drugs or an 18th century Englishman, your life belongs to you and you alone. You accept the responsibility for your life, and enjoy the promise that it won't be taken away from you.
Just like with our right to bear arms or our right to liberty or the pursuit of happiness, The opportunity is provided if you take the responsibility to procure it for yourself. Rights are doors that are open (or at least unlocked), it is completely our responsibility to walk through them. The promise of a right is simply the promise that these doors will not be unjustly closed off to us by the actions of others.

So in providing medicine, I would say I have a Professional Responsibility to provide the absolute best care possible to my patients. But according to my definition, I am in no way the provider nor the insurer of my patients right to Life. I am not responsible for their lives. Instead I voluntarily enter a contract to provide a service that the patient has requested. The patient requesting my services is the patient taking responsibility for their life.

This is probably the most concise and properly worded expression of my personal opinions. If I ever get into this debate irl I'm just going to pull this up...

+3

How can you call yourselves doctors and be against universal healthcare? Clearly most of you right wingers must have gone into medicine for the money.

Obvious troll is obvious.

-10

 

[GunnerBMS]

You're not even a good troll. Study your aspirational peers' posts for tips on how to troll better.

you're unbearable

 

[Ost3oclast]

How can you call yourselves doctors and be against universal healthcare? Clearly most of you right wingers must have gone into medicine for the money.

Try harder man

 

[armoman92]

our tax code already has physicians doing 30% of their work for free

Not to mention ICD coding. Average doctors are forced to maintain and build upon database that will be used to create medical AI's. The irony is these machines will replace them in the future.

Nothing here about medicine being free...

 

[dyachei]

Just a friendly reminder to keep it civil when responding to other posters, even when you don't agree.

 

[SpecterGT260]

I have recently read and seen some conversations of healthcare professionals and policymakers expressing their "concerns" about the idea that medicine is becoming a "right or entitlement." My first reaction was..why is this even a topic? I've always believed that every human (and living beings) are entitled to access to medicine as it leads to the fulfillment of the "Life" and "pursuit of happiness" principles set forth by the Deceleration of Independence. Yet, I really want to understand why some people, particularity physicians, might oppose such such a notion. Is it a fear of regulation,reduced revenue, decreased autonomy, or what? Approximately 60 countries in world have Universal Health Care systems (UHC), including almost every European country, Japan, Australia, New Zealand, and Canada. While these systems vary widely in their characteristics, services, and structures, they function based on the principle that every citizen is entitled to healthcare. These countries, of course, have private sectors, that run parallel to the UHCs but there is still a choice for those who cannot afford private medical service. Please understand, I'm NOT trying to debate the efficiency of ANY healthcare system because I know that no system is perfect and each has it's own pros and cons. However, I just marveled at the fact that some debate whether medicine should be a right in the first place and wanted to know the reasons behind such a stance.

EDIT: Which books, articles, or studies would you recommend that cover both sides of the issue?

The biggest problem with your reasoning is that you assume as a matter of fact that for people to believe something isn't a "right" that they also believe that people should be denied it.

Healthcare isn't a right. The term "rights" has meaning and if you look throughout our culture, laws, and history you will see one prevailing theme about rights: they do not impose on other rights and they do not compel others to act. Now, I think universal healthcare would be awesome and would gladly grant it if I had that power, but this doesn't make it a right and honestly, treating it as a right isn't the way to achieve this goal. The issue is that there are limited resources. A line has to be drawn somewhere but the scope of healthcare is so broad that defining it as a basic human right will only bleed the system dry until nobody gets it. So let's say healthcare is a right. "Well gee, that guy got fluid resuscitated for free. Why can't I have my nose job for free too?" Both are healthcare services. So do we draw the line at "life saving"? Is that what people are innately entitled to? This wouldn't address the original point which is to provide preventative services but how would could we define the system such that it worked? The other issue would be compelling physicians to act. We have a duty to patient's but it isn't because they have the right to our service. It is a personally-assumed duty. The idea of duty works here because it includes the concept that someone will sacrifice something for another, in this case the sacrifice is time and energy. If healthcare were a right a physician could not ever, under any circumstances, refuse to see and treat without infringing on someone's rights. Fortunately, rights don't work this way. Staying silent during an arrest doesn't infringe on anyone else's rights. Finally, having the right to life means the right to not have it taken. Not the right to compel someone to provide it for you .

It is really a semantics argument, but it is an important one because it comes down to what people perceive as rights and what it means when something is or isn't a right.

 

[bc65]

I'll also add that there have been multiple studies which found that the vast majority of an individual's health expenditures in their lifetime occur in the last 3 weeks

if we could save even a quarter of what medicare pays for care in the last few weeks of life we could do a lot of good things with that money

This observation reminds me of a Bazooka bubble gum joke I read when I was 6 years old.
Question: " What stop should I get off the bus?"
Answer: " See where I get off, and then get off the stop before that one".

Sure, severe illness is expensive, and it often leads to death. Other severe illness is expensive, and leads to a cure and a lot of healthy years. Unfortunately, it's often impossible to know the difference in advance. I won't waste your time or mine in giving you lots of anecdotes. I understand the reality behind that statistic, but it doesn't really lead to a solution. Or perhaps we could take it a step further: Let's evaluate patients before we admit them to the hospital. If they're sick, don't let them in.

 

[dpmd]

This observation reminds me of a Bazooka bubble gum joke I read when I was 6 years old.
Question: " What stop should I get off the bus?"
Answer: " See where I get off, and then get off the stop before that one".

Sure, severe illness is expensive, and it often leads to death. Other severe illness is expensive, and leads to a cure and a lot of healthy years. Unfortunately, it's often impossible to know the difference in advance. I won't waste your time or mine in giving you lots of anecdotes. I understand the reality behind that statistic, but it doesn't really lead to a solution. Or perhaps we could take it a step further: Let's evaluate patients before we admit them to the hospital. If they're sick, don't let them in.

Actually, there are plenty of times where you can tell the difference and those are the scenarios where making sure people are informed about their condition and having them make advanced decisions help.

 

[bc65]

Actually, there are plenty of times where you can tell the difference and those are the scenarios where making sure people are informed about their condition and having them make advanced decisions help

So, you agree. I said "often impossible", and you said "plenty of times you can".

Even when you don't expect a cure, you still may want to prolong life a few months or even a few weeks. ( Remember, life itself is a terminal condition ).
Last night on tv there was a show on just this topic, a tv version of Atul Gawande's book, "Being Mortal". I saw just a bit of it, which was the story of a woman in her 30's with terminal lung Ca, who was diagnosed during pregnancy and was dying with a newborn. ( She couldn't tolerate general anesthesia for the delivery and had to deliver with a pneumothorax ). They were discussing the types of treatments she had received, but in a case like that, I think an extra month of life, giving the baby a chance to experience being held by her mother, and giving her mother the chance to hold her, is worth a lot. I would pay out of pocket for that extra time if that were my family. Someone who did her residency with died of breast cancer a few years ago. She got treatment to the very end so that she could attend her son's high school graduation followed a week later by her daughter's college graduation. It meant a lot to that family, and to her, that she was able to see them off into adulthood. She was in a wheelchair at the ceremonies, and she died a week later.

So, yes, sometimes we try because we don't know the outcome, sometimes we do it because the family insists and either doesn't understand the futility or refuses to face reality, sometimes we do it so we won't be sued, and sometimes we do it to get a few more weeks for a good reason. Also, let's not forget that a lot of end-of -life care is palliative, but still expensive.

I don't think that very many doctors treat patients during their last illness without understanding what they are doing and why. Obviously you don't think that you're the problem, and I don't think that I'm the problem. It must be those "other " doctors who don't know what they're doing. Or maybe, as I believe, the treatment is mostly appropriate and that statistic is not revealing a problem at all.

 

[SpinalFusion]

This is probably the most concise and properly worded expression of my personal opinions. If I ever get into this debate irl I'm just going to pull this up...

+3

Well, shucks. Glad I could give your inner decapod a voice!
In all honesty I'd like to thank the PETA and GreenPeace folks who wait to ambush me outside my grad office for helping me sort out my own inner thoughts!