Should medicine be an entitlement?

[SpinalFusion]

( Remember, life itself is a terminal condition ).

So often, it seems, this seems to be forgotten!

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[dpmd]

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.

Interesting you bring up cancer since a couple of late stage cancers have been shown to do better in hospice rather than with aggressive treatment, yet those are often the patients i see still getting chemo and rads despite major ill effects because the oncologists continue to push for it and haven't actually told the patient they aren't going to be cured iust palliated "because then they wouldn't want to take the chemo" as one oncologist straight up admitted to me. So i disagree with your premise that there isn't a problem and i would guess that the amount of care provided despite the doctor knowing it isn't going to improve quality of life or meaningfully prolong it simply because the discussion that should have started months ago wasn't held is a large proportion of the expenditures.

 

[Stagg737]

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.

I'm not saying that there aren't times when we should try and cure people with possible terminal illnesses or even that we shouldn't prolong life in certain situations. What I'm saying is that there are immense numbers of cases where everyone knows the patient is dying and palliative care is the only option, yet that patient is given expensive therapies or surgical treatments with low odds of 'success' (I'm talking a percent of a percent) which will only extend their life a few weeks and will do little to improve their condition. Weigh that against the potential suffering a patient will go through from staying alive or even from the treatment itself and imo it's not worth it.

Like I said, a major issue is that people don't understand how to deal with or accept death when it is inevitable. There is a difference between realistically fighting for a reason and fighting out of fear. Hospice and palliative care has frequently been shown to not only be cheaper, but also a more successful form of treatment which allows the patients to have a higher quality of life during their final weeks/months/even years. dpmd also brings up another great point about end of life conversations, if more people conveyed their wishes to family or even to their PCP, then we would not only be able to fulfill patients' wishes better, we'd be able to take a significant chunk out of that 125 billion being used on expensive end of life care and put it to other uses.

 

[PL198]

if you think medicine is an entitlement you're beyond delusional.

 

[bc65]

Interesting you bring up cancer since a couple of late stage cancers have been shown to do better in hospice rather than with aggressive treatment, yet those are often the patients i see still getting chemo and rads despite major ill effects

What I'm saying is that there are immense numbers of cases where everyone knows the patient is dying and palliative care is the only option, yet that patient is given expensive therapies or surgical treatments with low odds of 'success'

Despite my somewhat snarky response above, I really don't think we disagree. ( On my 3rd year medicine rotaion, one of my residents tried to fail me because I complained about a terminal patient getting yet another round of experimental chemo. They made me talk with the head of Oncology. ) All I'm saying is that the often quoted statistic about most care being spent on the last illness is not necessarily reflective of inappropriate care. I agree that some of that expense is counterproductive, but I suspect that much of it, if not most of it, is appropriate, for the reasons I cited above.

I only occassionally get involved in making treatment decisions for metasatic disease, and I would often recommend against what I would consider to be futile treatments. But even informed patients want to try. I read a study recently ( I don't know where, so don't ask ) that showed a huge divergence between the agressive care patients want for themselves, and the much less aggressive interventions that doctors want for themselves. So I believe that if there is a problem, the problem isn't with us, it's with the public.

Even there, though, it will depend on your point of view. A few months ago, our entire surgery department was forced to go through a "roll-playing" exercise, conducted by the newly-formed department of palliative care. The scenario they presented was of an elderly demented woman with a leaking AAA. I was assigned the role of her 87 year old husband. I didn't want to participate, but I made them pay for their mistake. The vascular surgeon explained the situation to me, and I said " if she has no chance of survival if you don't operate, and a very small chance of surviving if you do, you should operate". He got very frustrated, so the head of palliative care stepped in to show him how to convince me. It didn't work, and she was literally in tears after arguing with me. Why? Because, in the real world, pretty much every family would appropriately want to operate. After all, there's nothing to lose, and everything to gain. If she dies, it would be on the table, or within 24-48 hours, so why not try? Plus, not trying would raise more ethical issues than trying, even for me as a physician, not just as an imaginary husband. Again, all I'm saying is that many of these allegedly inappropriate end of life decisions are not so inappropraite when you look into them.

On the other hand, I also remember the family of a 22 year old woman dying of mets to her brain who arrested, and the family screaming in the hallway outside her room, demanding that she be coded. They coded her. I have always thought of that as the quintessential example of useless end of life treatment. And yet, when I think about it now, why not code her if that's what the family wants? Do a slow code, and the family knows that "everything was done" and they can sleep better at night. I consider some of those end of life treatments to be the modern equivalent of last rites. Somehow, the family feels better and the patient's soul can rest if they go out with the ritual of electrocution and rib fractures. Cracking open the code cart wasn't that expensive, and it bought them peace of mind, and may have avoided a lawsuit.

 

[dpmd]

Despite my somewhat snarky response above, I really don't think we disagree. ( On my 3rd year medicine rotaion, one of my residents tried to fail me because I complained about a terminal patient getting yet another round of experimental chemo. They made me talk with the head of Oncology. ) All I'm saying is that the often quoted statistic about most care being spent on the last illness is not necessarily reflective of inappropriate care. I agree that some of that expense is counterproductive, but I suspect that much of it, if not most of it, is appropriate, for the reasons I cited above.

I only occassionally get involved in making treatment decisions for metasatic disease, and I would often recommend against what I would consider to be futile treatments. But even informed patients want to try. I read a study recently ( I don't know where, so don't ask ) that showed a huge divergence between the agressive care patients want for themselves, and the much less aggressive interventions that doctors want for themselves. So I believe that if there is a problem, the problem isn't with us, it's with the public.

Even there, though, it will depend on your point of view. A few months ago, our entire surgery department was forced to go through a "roll-playing" exercise, conducted by the newly-formed department of palliative care. The scenario they presented was of an elderly demented woman with a leaking AAA. I was assigned the role of her 87 year old husband. I didn't want to participate, but I made them pay for their mistake. The vascular surgeon explained the situation to me, and I said " if she has no chance of survival if you don't operate, and a very small chance of surviving if you do, you should operate". He got very frustrated, so the head of palliative care stepped in to show him how to convince me. It didn't work, and she was literally in tears after arguing with me. Why? Because, in the real world, pretty much every family would appropriately want to operate. After all, there's nothing to lose, and everything to gain. If she dies, it would be on the table, or within 24-48 hours, so why not try? Plus, not trying would raise more ethical issues than trying, even for me as a physician, not just as an imaginary husband. Again, all I'm saying is that many of these allegedly inappropriate end of life decisions are not so inappropraite when you look into them.

On the other hand, I also remember the family of a 22 year old woman dying of mets to her brain who arrested, and the family screaming in the hallway outside her room, demanding that she be coded. They coded her. I have always thought of that as the quintessential example of useless end of life treatment. And yet, when I think about it now, why not code her if that's what the family wants? Do a slow code, and the family knows that "everything was done" and they can sleep better at night. I consider some of those end of life treatments to be the modern equivalent of last rites. Somehow, the family feels better and the patient's soul can rest if they go out with the ritual of electrocution and rib fractures. Cracking open the code cart wasn't that expensive, and it bought them peace of mind, and may have avoided a lawsuit.

Both of those examples probably would have gone differently if the patient had actually been able to be part of the decision making process in advance and the family had time to adjust to the plan. However, change the leaky aaa to something i actually deal with like a perfed bowel or something and i have declined to operate in similar circumstances before. The problem is in talking about the small chance of life with the surgery but instead discussing that it is very likely the patient will die regardless of what you do and that nothing is going to get her back to how she was and the most likely result of surgery is more suffering followed by death and therefore i am not going to offer it. Takes it out of making the family make a choice about chance versus no chance and focuses things back on what really matters which is not inflicting suffering (which is inherent with surgery) without good reason.

Also, i think slow codes are the opposite of ethical behavior. You either need to gonad up and tell the family why you aren't going to do it or you need to actually do it. Don't perpetrate a lie just to try to satisfy the family.

 

[Lifebloom]

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[bc65]

Both of those examples probably would have gone differently if the patient had actually been able to be part of the decision making process in advance and the family had time to adjust to the plan

I disagree.

I don't know the details of the brain met case, but I would assume that they had been talked to about prognosis for months. They just refused to accept it. That's not unusual.

As for a case where there's a choice between a small chance and none: taking the small chance is a reasonable choice. It may not be yours, but many people will make that choice, and they will sometimes end up with a cure. We're not talking about a case where there is NO chance, e.g. mets to the brain.

I can't speak to your experiences, of course, but I have certainly had patients who proceeded with chemo against my recommendation and wasted their last days puking with virtually no chance of success, so to assume that all surgical patients would decline surgery under more favorable circumstances is a mistake.

instead discussing that it is very likely the patient will die regardless of what you do and that nothing is going to get her back to how she was

As you note, "the patient will very likely die" if you DO operate, but he will definitely die if you don't.

After being presented with the facts, some will choose surgery, and some won't. Either choice would be acceptable, depending on the case. You stipulated that " nothing will bring her back the way she was". There's no reason to assume that that will always be the case. Maybe for the patient you have in mind, but not for the one I'm considering. Maybe it depends on your anesthesiologist.

The pain and suffering of operating and will be no worse than the pain of an untreated leaking viscus. In both cases, treat the pain appropriately.

change the leaky aaa to something i actually deal with like a perfed bowel

It's one thing to refuse to operate on demented 92 year old with confirmed diffuse ischemic bowel, but quite
another if you have a spry 85 year old with a ruptured appendix or a perfed gastric ulcer. I would certainly operate on the latter, and I'll bet you would too. The ischemic bowel patient isn't going home, but a perfed bowel- Why not? My oldest patient was a 99 yo. with a perfed cecum from a colonoscopy for lower g.i. bleeding. We did a colostomy and he went home a few days later. He was otherwise healthy, and should have had a 2-3 year life expectancy, as he would have had without the perforation.

i think slow codes are the opposite of ethical behavior. You either need to gonad up and tell the family why you aren't going to do it or you need to actually do it. Don't perpetrate a lie just to try to satisfy the family.

Why not satisfy the family? It's one of things we're supposed to do. Why be mean just to prove a point to yourself? Doctors do things to make patients happy all the time. That's my job.

 

[dpmd]

I disagree.

I don't know the details of the brain met case, but I would assume that they had been talked to about prognosis for months. They just refused to accept it. That's not unusual.

As for a case where there's a choice between a small chance and none: taking the small chance is a reasonable choice. It may not be yours, but many people will make that choice, and they will sometimes end up with a cure. We're not talking about a case where there is NO chance, e.g. mets to the brain.

I can't speak to your experiences, of course, but I have certainly had patients who proceeded with chemo against my recommendation and wasted their last days puking with virtually no chance of success, so to assume that all surgical patients would decline surgery under more favorable circumstances is a mistake.




As you note, "the patient will very likely die" if you DO operate, but he will definitely die if you don't.

After being presented with the facts, some will choose surgery, and some won't. Either choice would be acceptable, depending on the case. You stipulated that " nothing will bring her back the way she was". There's no reason to assume that that will always be the case. Maybe for the patient you have in mind, but not for the one I'm considering. Maybe it depends on your anesthesiologist.

The pain and suffering of operating and will be no worse than the pain of an untreated leaking viscus. In both cases, treat the pain appropriately.



It's one thing to refuse to operate on demented 92 year old with confirmed diffuse ischemic bowel, but quite
another if you have a spry 85 year old with a ruptured appendix or a perfed gastric ulcer. I would certainly operate on the latter, and I'll bet you would too. The ischemic bowel patient isn't going home, but a perfed bowel- Why not? My oldest patient was a 99 yo. with a perfed cecum from a colonoscopy for lower g.i. bleeding. We did a colostomy and he went home a few days later. He was otherwise healthy, and should have had a 2-3 year life expectancy, as he would have had without the perforation.


Why not satisfy the family? It's one of things we're supposed to do. Why be mean just to prove a point to yourself? Doctors do things to make patients happy all the time. That's my job.

I wouldn't make you assumption because I know better now. I know oncologists who absolutely do not discuss the reality of the prognosis with patients, particularly young ones.

My job as a surgeon is to decide when an operation is worth the risk. A spry 99 y/o with an appy that isn't a good nonoperative management candidate, sure I will offer a surgery. A demented 85 yo in a condition where i think intraop or immediate post op death is the most likely result, i don't even offer it. I don't feel like people need to due with my incision on them just so the family can be satisfied that I "tried everything". The fresh perf from a scope (so there isn't **** everywhere) isn't typically going to present with sepsis that makes me worried they are going to die quickly so that makes things different, but if they are badly demented i am going to make damn sure the family realizes this isn't going to fix the dementia and that making them comfortable until they die might be a challenge but it can be done instead of operating and having the challenge of controlling pain in a patient who can't really tell us what they feel and won't understand why they hurt.

My job isn't to make patients happy. Often times my job is in direct opposition to making them happy. My job is not to make the famiky happy. My job is to do what is right for the patient. Maybe sometimes that is hard to define and maybe it isn't the same for every patient, but you cannot convince me that torturing a corpse without the goal of bringing them back to life is right for any patient regardless of what their family says. Direct cardiac massage is probably better at pushing blood around but I'm not going to crack a chest just because a family asks me to "do everything" (not going to call ecmo team either)

 

[PL198]

Interesting statement.

it's a fact, not a statement. you have a service that is produced at the expense of others time and resources. such a service would never be an entitlement. food isn't an entitlement and food is certainly easier to get than medical care....

if people deserve medical care, why don't all animals? why is it ok to squash a spider. what is it about human life that is somehow sacred, but all other organisms aren't? nothing, because no life is sacred.

 

[bc65]

My original contention was that the observation that most medical expenditures are incurred in the last weeks of life does not necessarily indicate that such care was not appropriate. I have seen no argument to prove otherwise.

I then stated that if a patient was offered a choice between no chance and a small chance, that choosing the small chance was the logical decision. I stand by that statement as well. I did not recommend operating in the absence of appropriate indications.

You said that if you didn't want to operate, you wouldn't offer surgery. Many cases have treatment options. If there are options, they should be offered to the patient. Surely you're not suggesting going back to the days when the doctor made the decision, kept the diagnosis to himself, and did as he wished ( back then it was always 'him', not 'her'). Those days are long gone.

To bolster your argument, you said that we should "change the leaky aaa to something i actually deal with like a perfed bowel or something and i have declined to operate in similar circumstances before". Per your request, I then gave several examples of perforated bowel, including two where I would recommend surgery, and one which I would not operate on. In fact, you agreed with those cases, and said you would operate. So exactly what you are disagreeing about?

you cannot convince me that torturing a corpse without the goal of bringing them back to life is right for any patient regardless of what their family says

The default is CPR, in the absence of a DNR order. If a patient is not DNR, they should be coded.

As for the enthusiasm and aggressiveness with which it is performed, it will certainly vary with the history and age and prognosis of the patient. I expect that an acute respiratory arrest in an asthmatic 9 year old will be coded more agressively than a 90 year old in the ER with a cardiac arrest.

No one would recommend open cardiac masage or ecmo for such patients, nor would it be appropriate or indicated. Both are extremely invasive, wheras CPR need not be. Of course, you know that. I will excuse the hyperbole.

 

[wjs010]

A gym can make me healthy and live longer. Where's my free gym membership? Good healthy food can do the same.. Where's my free food from whole foods?

 

[PikminOC]

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?

Medicine is already an entitlement.
Look at Medicare and Medicaid.

 

[PL198]

Medicine is already an entitlement.
Look at Medicare and Medicaid.

both jokes

 

[Lifebloom]

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[Lifebloom]

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[Lifebloom]

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[PL198]

Are you actually serious?

no people should be able to pay pennies on the dollar for services just because of some arbitrary believe that human life is somehow sacred.

 

[panamerica]

no people should be able to pay pennies on the dollar for services just because of some arbitrary believe that human life is somehow sacred.

Thanks for nicely summing up the odious nature of the beliefs that underly your particular brand of reactionary conservatism. People are just meat, and deserve no more consideration than cattle.

 

[PL198]

that's right, they don't.

can you prove why they should without using emotion? all the arguments people use in response to this typical result in the words " civilized " "barbaric" etc, when those really mean nothing when debating policy. give me an argument devoid of emotion

 

[Lifebloom]

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[panamerica]

that's right, they don't.

can you prove why they should without using emotion? all the arguments people use in response to this typical result in the words " civilized " "barbaric" etc, when those really mean nothing when debating policy. give me an argument devoid of emotion

DAE even logic? The arrogance of an-caps is hilarious. As of there isn't a huge corpus of philosophical work supporting humanism and the principles of social justice. Instead of asking me to convince you of an obvious truth, why don't you go out and read some Rawls or even some ****ing Dostoevsky. Anything but the impoverished **** that consitutes the an-cap canon. Hell, go read haidt's book on moral reasoning to understand why your claims to logical objectivity are highly suspect in and of themselves.

 

[PL198]

DAE even logic? The arrogance of an-caps is hilarious. As of there isn't a huge corpus of philosophical work supporting humanism and the principles of social justice. Instead of asking me to convince you of an obvious truth, why don't you go out and read some Rawls or even some ****ing Dostoevsky. Anything but the impoverished **** that consitutes the an-cap canon. Hell, go read haidt's book on moral reasoning to understand why your claims to logical objectivity are highly suspect in and of themselves.

nice try

 

[PikminOC]

both jokes

Jokes how? Please expound on this.
Single payor is like the VA.
How's that doing?

 

[GUH]

If you are poor and lets say an immigrant barely able to speak english, there is nothing you can do to escape the toxic poor food quality in this country. By the age of 55 you will be in the ER with a coronary.

Great! So you should agree with what that poster said, since free food from Whole Foods will directly address this problem, right? Just have everyone else pay for health foods for those who refuse to pay for it themselves. Especially for those immigrants, many of whom have no right to be here in the first place.

 

[panamerica]

nice try

Its hard to convince someone of something that should be axiomatic to their very existence and day to day interactions. Maybe you are just deficient in that human quality that tells us that others have value. Or maybe you are just confused.

In any case, its a sad way to experience life.

 

[IlDestriero]

Healthcare should be free or very cheap.
Ok.
Food and shelter should be free or subsidized as well. Good nutrition and a safe environment are probably more important to your health than access to care when you're sick.
Government housing and food stamps for all.
I will probably need them as well as I will be providing Medicare to all for 1/3 of the going rate for my services.

 

[panamerica]

Great! So you should agree with what that poster said, since free food from Whole Foods will directly address this problem, right? Just have everyone else pay for health foods for those who refuse to pay for it themselves. Especially for those immigrants, many of whom have no right to be here in the first place.

Sometimes I wish time travel were a thing, purely for the purpose of allowing the modern conservative to go back to the Utopian days of the early industrial revolution before we ruined everything with evil social safety nets.

 

[touchpause13]

no people should be able to pay pennies on the dollar for services just because of some arbitrary believe that human life is somehow sacred.

Wait a hot minute

Aren't you anti abortion?

 

[GUH]

Sometimes I wish time travel were a thing, purely for the purpose of allowing the modern conservative to go back to the Utopian days of the early industrial revolution before we ruined everything with evil social safety nets.

If you think safety nets are necessary, then why not have a healthy food safety net? I, for one, would love to walk into a Tendergreens or Whole Foods and eat well on someone else's dime. With my budget it's unusual for me to be able to do so.

 

[panamerica]

If you think safety nets are necessary, then why not have a healthy food safety net?

Ideally that is what food stamps and wic would achieve. So why not indeed?

 

[GUH]

Ideally that is what food stamps and wic would achieve. So why not indeed?

You and I both know that food stamps absolutely do not encourage healthy eating. Try bringing your EBT to Tendergreens. If you really think that everyone has a right to healthy food paid for by someone else, then you should not support food stamps.

(This video has some NSFW lyrics):

 

[touchpause13]

If you think safety nets are necessary, then why not have a healthy food safety net? I, for one, would love to walk into a Tendergreens or Whole Foods and eat well on someone else's dime. With my budget it's unusual for me to be able to do so.

Honestly you can get food that's as healthy as whole foods at Aldis. They are owned by the same company as Trader Joes for fs sake.

 

[panamerica]

You and I both know that food stamps absolutely do not encourage healthy eating. Try bringing your EBT to Tendergreens. If you really think that everyone has a right to healthy food paid for by someone else, then you should not support food stamps.

Which is why I said ideally. You are arguing against a particular implementation, not the underlying principle.

 

[giantswing]

No. I will never advocate that it's my responsibility to take care of someone that doesn't want to take care of themselves. Ever. It's not in the social contract. Not even the fine print. And why exactly wouldn't I want to live in a place where people are held responsible for their own actions?

Are you a third year yet? Cuz you're going to HATE third year.

 

[Lifebloom]

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[PL198]

Wait a hot minute

Aren't you anti abortion?

nope

 

[MajorBubblez]

this thread is the gift that keeps on giving

 

[PL198]

Jokes how? Please expound on this.
Single payor is like the VA.
How's that doing?

I know, the VA is terrible. I'm saying it doesn't work.

 

[PL198]

Sometimes I wish time travel were a thing, purely for the purpose of allowing the modern conservative to go back to the Utopian days of the early industrial revolution before we ruined everything with evil social safety nets.

yes that's logical. someone doesn't agree with you, so you want them to time travel away. heck, why not just kill them, why mess with time travel?

 

[Eokpar02]

Help! I'm being enslaved! Somebody call Amnesty International!

We are talking about governments having to provide basic health care to their citizens, not physicians being forced to work for free. To achieve this goal, since governments are not corporeal beings with a medical degrees, they are going to have to employ the services of physicians with actual money.

What evidence do you have that the government can provide adequate healthcare to anyone? Look at the VA for example; the government couldn't even provide a handful of needy vets humane treatment.

 

[touchpause13]

nope

ok.
Consistency noted.

 

[Eokpar02]

Here's a simplified argument for universal coverage.

1) The primary function of government is to do everything possible to ensure the wellbeing of its citizens. (Note: bad governments, such as Stalin's Soviet Union, present day North Korea etc. placed the government above its people. Invasion of other countries are a different issue entirely even if done for the wellbeing of its citizens.)

2) Healthcare coverage for all citizens would increase the wellbeing of all( healthier individuals, healthier populations, better hygiene and so forth).

3)Thus universal health care should be mandatory from a purely utilitarian perspective regardless of your own views on the matter ( entitlement vs right).

Instead we have a dramatically more expensive system ( most expensive in the world per capita) with limited coverage for its citizens and a lackluster life expectancy compared to other developed nations. But it is okay because it is "more American"/ a few individuals can get stupidly rich off it.

1. The primary function of government is to grow larger and to assist those who support most vehemently. The federal government of the USA engages in acts that severely harm the average citizen. The greatest example of which is the drug war; where the government at all levels cages people for consuming things and engaging in voluntary interactions. Another example would be all the corporate welfare (tariffs, handouts, etc..). No reasonably intelligent person can look at government and say that its job is to ensure the welfare of its citizens given its track record.

2) If this were true, why can't the government ensure the well being of a few thousand veterans via the VA?

3) America's system is expensive because: 1) all the government subsidies which bid up the price. 2) The patient populations' desire to get fat, smoke and drink themselves into oblivion. 3) The growing popularity of elective procedures. The numbers that people cite for American healthcare include a lot of non-necessary procedures like bariatric surgeries, plastic surgery, and other medical interventions that have not been proven to lengthen people's lives at all.

 

[Eokpar02]

You may be interpreting their emotions on the matter through your own perspective. That's not always necessarily a mistake, but I think it's causing some misinterpretation here.

I think I might fall into the category you're attempting to describe here, and I'll tell you how I feel about it:
1. First, 'the government' doesn't exist. You can't literally point at the government. You can find people who 'work for' the government, and you can find buildings related to it, but there is no such thing in reality. It's just an idea in peoples' minds. This is to say that 'hating the government' is like hating dragons. I don't think it would be appropriate to say anybody really hates either.
2. People acting through what they believe is the will of the government take money from other people by force (often from high-earners like physicians). This act in and of itself is wrong. Anything that these people choose to do with it after the fact is largely immaterial. Even if they donated it to cancer-stricken orphans, the fact remains that the money was unjustly taken. Also, many argue (as alluded to above) that taking money from someone by force is retro-actively enslaving them. The time they spent to earn that money is now yours. You forcing someone to work for you without pay = slavery.
3. The above point answers the '[they] think anything [the government does] is bad.' It's not that every function of the government is bad if it were achieved through a peaceful/voluntary method. I think roads are great. On the other hand, if roads are built using slave labor, I'm going to have a problem with that aspect of it.

tl;dr: the government is bad and it should feel bad.

1. I have heard a lot of people say this and I disagree. Government is made out of the people who work for it. I can point towards the people and the things it uses violence to defend and call its own.

 

[Pacna]

1. I have heard a lot of people say this and I disagree. Government is made out of the people who work for it. I can point towards the people and the things it uses violence to defend and call its own.

Your logic is circular. "Government is made of people, and I can point at the people and things it uses." It is just an idea. If you're arguing that the idea exists and is widely shared, then I think that's pretty hard to challenge. What I meant is that it doesn't exist in any kind of morally-responsible or tangible way. If a soldier of an army of 100 dies, the government is not reduced by 1%.

 

[jdh71]

I know, the VA is terrible. I'm saying it doesn't work.

Actually. The VA works pretty good for the most part.

 

[deleted480308]

Actually. The VA works pretty good for the most part.

Employee physicians paid below market rates, long waits for treatments, staff dishonest enough to hide those waits, and horrible distribution that requires multiple hour drives for many veterans? It's a mess

 

[DocVader1990]

1. The primary function of government is to grow larger and to assist those who support most vehemently. The federal government of the USA engages in acts that severely harm the average citizen. The greatest example of which is the drug war; where the government at all levels cages people for consuming things and engaging in voluntary interactions. Another example would be all the corporate welfare (tariffs, handouts, etc..). No reasonably intelligent person can look at government and say that its job is to ensure the welfare of its citizens given its track record.

2) If this were true, why can't the government ensure the well being of a few thousand veterans via the VA?

3) America's system is expensive because: 1) all the government subsidies which bid up the price. 2) The patient populations' desire to get fat, smoke and drink themselves into oblivion. 3) The growing popularity of elective procedures. The numbers that people cite for American healthcare include a lot of non-necessary procedures like bariatric surgeries, plastic surgery, and other medical interventions that have not been proven to lengthen people's lives at all.

1)I was talking about an ideal govt but vent away.

2) This does not even address my point and is purely anecdotal.

3) Americas system is expensive because of basic economics. You decrease spending by cutting a middle man. In the US we added a middle man in the insurance companies, costs went up. This is a system designed to make money, not to benefit society. Unnecessary procedures are secondary to this "free market healthcare" and are actively encouraged by policy and current individualistic societal values.

My reply will of course be meaningless to you since your anti-govt biases are readily apparent but here goes. To reiterate ( for the 3rd time in one stupid thread) the primary function of the govt. is to serve its people. The US govt. does this by providing funding for public order (police spending, defense spending, military spending) and maintaining proper infrastructure ( roads, stoplights, transportation) all of which is funded by taxes. Unless you have Down Syndrome there isn't much to disagree with in what I said.

Interestingly these public services are not seen by many as an entitlements but wait a second....they are.You want roads? Work harder and pay for them yourself.

And if medicine is an entitlement that should be forbidden then all public services should be suspended for being entitlements too, it is only logical. From welfare to unemployment insurance, plowing the roads during winter, building bridges, fixing highways, every last one of them gone.

Obviously I am being sarcastic. We don't live in a world where military spending or road spending will be more important than healthcare right?? WRONG! Welcome to the United States of America, a country with more military spending than the rest of the world combined ( even after spending cuts!!!!).

Why can't the govt provide free health care for all? Is that not its purpose? To serve and protect its citizens. That why we have a govt. The answer given by many is always one of principle and conservative thinking. "It's not American!" goes the stupefying rallying cry of masses. This issues reveals the hypocrisy that currently permeates modern American thought. We would gladly allow the govt to prioritize and spend trillions on military spending but never allow it to spend a portion of that to provide healthcare for all its citizens.

 

[PL198]

Actually. The VA works pretty good for the most part.

so when there aren't major cover-ups, long waits, poor pay you mean?

 

[jdh71]

Employee physicians paid below market rates, long waits for treatments, staff dishonest enough to hide those waits, and horrible distribution that requires multiple hour drives for many veterans? It's a mess

That's not a fair representation at all. Physician pay is lower but they don't work as hard. Most treatments don't need to be done "right now" and can wait. No one makes vets live hours from their medical care and if there is anything emergent local services are covered. The staff who hid the outpatient visit wasn't a systemic phenomenon and occurred in only a few locales. It work great for almost all veterans. It's not perfect, nor does it claim perfection but it's not a mess. Not even close.