>Debbie asked- >OTOH, where *does* oneš hold the line on health costs?
This is a doozie to work through, maybe we can start this one bit at a time and try an international flair. So far to date (after some schooling and thinking) I like the Australian System best. Philisophically I figure that "first world" countries should be advanced enough that basic healthcare should be a starting point- IIRC in Australia, every individual has a basic plan and individuals can "buy up" to other levels. I am not a huge fan of "heroic" life prolonging measures, so I guess part of my answer is "what should everyone have" and the other boundary is "what is a realistic accepted level of care". Some millionaires (and actors in Christopher Reeves case frex) will always be able to "buy up" or get into experimental plans. To some degree I see people do this every day, some people pick the HMO version with limited options for physician care in comparison to a PPO/fee for service plan (or higher coverage/lower deductible plans) because they do not have the money to pay the childcare, etc (How many of us would choose to put a family member in an experimental program that could be of no benefit/placebo/damaging when we are not under the emotional strain of coping with a family member that may die? (How many people think about the level of care they want for themselves if they get sick- although it might be a bit less intimidating than setting up your own funeral plans). For lack of a better starting point, there is routine care, and respect of life. Flu/pneumonia do not claim the lives they used to, I can remember when Medicare finally started to pay for flu shots. Strokes and heart attack medical care has advanced and become more routine for example. Respect of life is easiest to perceive when it comes to hospice, but there are everyday patient rights that also play in here (I am not talking about people demanding the "best/most extreme" care, but respect and rights to basic "quality of care"/treatment). My other concern is that "holding the costs" ends to be a reactive philosophy. Some posters have already noted that preventive measures can have good return on investment. There is no simple answer. For example, I hear people complain about skyrocketing costs of malpractice insurance and general insurance rates- the common sound bite is the lawyers are ruining the system but I heard a great article on NPR about how several studies have shown that these rates increase when the interest rates/etc are diminished and the insurance companies really have to make money off premiums and not the interest/investments they have. The fallacy of managed care has been over for more than 5 years- the worst cases of HMO type bankruptcies on the east coast were not this year- yet we are just hearing about the insurance company suffering to provide care now. Sorry for the digressing, not the best thought out but didn't want to wait a month to respond. Good news is my mind is still malleable- nothing is concrete in this work of progress (or so I like to think). Dee- now off to rest my wee brain (is it friday yet? :-) _______________________________________________ http://www.mccmedia.com/mailman/listinfo/brin-l
