Re: health care levels and costs
--- [EMAIL PROTECTED] wrote:
Debbi asked-
snip
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.
Could you expand on this?
Let me try a few angles on this one and see if they
help.
-the classic is flu shots and annual exams, such a
minimal price
to cover in light of the costs to cover the problems
that can result
from lack of care (prolonged hospital stays, etc)
-Insurance hold the costs and restrict how much
they pay on meds,
so people have to halve their meds or try and do
without them- the
long term detriment is more costly than the meds
-After heart attacks (and the associated costs)
people think about
regular exercise, but insurance companies rarely
offer true preventive
fitness incentives or even coverage for post heart
attack maintenance.
-while prenatal care coverange has dropped infant
mortality, (there is
discussion of some of these benefits being dropped
due to budget
constraints) yet basic healthcare for well
babies/children is often still not available
Ah. Yes, there does appear to be a 'penny wise but
pound foolish' outlook in a lot of so-called health
care plans. ('Maintenance,' after all, doesn't imply
_improving_ one's health... ;P ) Same goes for
programs that educate patients about their chronic
illness(es); it takes time to teach someone how
diabetes affects them, how they can affect the course
of the disease, and _why_ they should do so (not to
please their clinician, but because it benefits them
directly). Having a genuine relationship with a
clinician helps people make this jump, in my
experience, but you can't bond with someone in a
couple of 10-15 minute encounters.
OTOH, I really would like to see more people 'take the
reins' WRT their own health; I do think progress has
been made on that front over the past 2 decades, so
maybe I'm just being impatient... :)
Debbi
Paternalism Shouldn't Be Us Maru
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Re: health care levels and costs
--- [EMAIL PROTECTED] wrote: Debbie asked- [actually, it was Ronn] OTOH, where *does* one¹ 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. Does this mean a National Health Care System (what we would call a single payor plan), paid for by taxes? Traditionally this would be an option, however several states are currently looking at state plans (Maine I recall is one state). The other reason I would hesitate to use National Health Care System per se is the assumption that generally I think most posters would automatically think of the Canadian system of health care. I am not a huge fan of heroic life prolonging measures, My real objections here are in the case of severely limited resources, frex organs for transplant, going to people who caused their own problems (Mickey Mantle and David Crosby getting livers, after years of alcohol and alc/drug abuse). No one has been deprived of something because of Reeves' treatment. Agreed, I don't know much about the organ transplant priority list, but my vague understanding was it was pretty stringent for behavior and order of recipients. 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). Facing your own mortality is quite frightening - although for me it is not *death* but _loss of control before/while dying_ that terrifies. If I'm terminal - turn off the ventilator. If it's been 2 weeks of coma - same (or cease fluids/meds). Again, we tend to agree, this is one of the reasons I am an organ donor. Unless someone wants to make sure I get read Brin-l everyday :-) For lack of a better starting point, there is routine care, and respect of life... 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. Could you expand on this? Let me try a few angles on this one and see if they help. -the classic is flu shots and annual exams, such a minimal price to cover in light of the costs to cover the problems that can result from lack of care (prolonged hospital stays, etc) -Insurance hold the costs and restrict how much they pay on meds, so people have to halve their meds or try and do without them- the long term detriment is more costly than the meds -After heart attacks (and the associated costs) people think about regular exercise, but insurance companies rarely offer true preventive fitness incentives or even coverage for post heart attack maintenance. -while prenatal care coverange has dropped infant mortality, (there is discussion of some of these benefits being dropped due to budget constraints) yet basic healthcare for well babies/children is often still not available Dee ___ http://www.mccmedia.com/mailman/listinfo/brin-l
Re: health care levels and costs
At 09:21 PM 12/19/02 -0800, Deborah Harrell wrote: My real objections here are in the case of severely limited resources, frex organs for transplant, going to people who caused their own problems (Mickey Mantle and David Crosby getting livers, after years of alcohol and alc/drug abuse). No one has been deprived of something because of Reeves' treatment. OTOH, there was a story on the news the other day about a prisoner on death row who had received a heart transplant, and then died a few weeks or months later because he didn't take care of himself after surgery. Because he was in prison, though, the law said he was entitled to the best possible health care at public expense . . . In Larry Niven's Universe He'd Have Been A Donor Rather Than A Recipient Maru --Ronn! :) I always knew that I would see the first man on the Moon. I never dreamed that I would see the last. --Dr. Jerry Pournelle ___ http://www.mccmedia.com/mailman/listinfo/brin-l
health care levels and costs
Debbie asked- OTOH, where *does* one¹ 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
Re: health care levels and costs
--- [EMAIL PROTECTED] wrote: Debbie asked- [actually, it was Ronn] OTOH, where *does* one¹ 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. Does this mean a National Health Care System (what we would call a single payor plan), paid for by taxes? I am not a huge fan of heroic life prolonging measures, Me neither, in the case of terminal conditions or massive multisystem failure: while an 80 year-old with a mild-moderate heart attack - but no other significant problems - can go back to independent living and activities with proper treatment and rehab, a 65 year-old with the same heart attack - but on top of longstanding uncontrolled diabetes, renal failure, and emphysema - is going to do very poorly, no matter how well-treated. 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. My real objections here are in the case of severely limited resources, frex organs for transplant, going to people who caused their own problems (Mickey Mantle and David Crosby getting livers, after years of alcohol and alc/drug abuse). No one has been deprived of something because of Reeves' treatment. 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). Facing your own mortality is quite frightening - although for me it is not *death* but _loss of control before/while dying_ that terrifies. If I'm terminal - turn off the ventilator. If it's been 2 weeks of coma - same (or cease fluids/meds). For lack of a better starting point, there is routine care, and respect of life... 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. Could you expand on this? 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. There is certainly no simple prescription; any 'quick fix' would be like surgery without anesthesia - painful and difficult to perform as the patient writhes on the table. :( Debbi Beads And Rattles Maru __ Do you Yahoo!? Yahoo! Mail Plus - Powerful. Affordable. Sign up now. http://mailplus.yahoo.com ___ http://www.mccmedia.com/mailman/listinfo/brin-l
