Let Uninsured Die

Good question about not allowing a person to choose to die.  There is a difference between allowing death to come and taking a life.  We do allow patients to choose decline treatment and the natural medical consequence will be death.  That is comparable to the natural consequences Ron Paul spoke of for a person who makes an informed decision not to get medical insurance.

Medically assisting suicide is another discussion entirely.

Another dilemma with regards to making decisions for other people.  What gives us the right to put someone on life support?  Is that not playing God?  

You are correct. There are many technological advances that save lives.  But those same advances cost hundreds of thousands of dollars in situations where life was ready to be over.

Mr.Fok makes me mad.  I like to think he is not representative of the undocumented immigrants.  You are right, there is no easy answer, but there is a rather simple one.  It utilizes the cry of your pinto post...address the issue.

I'm going to try to pull all my thoughts together in a response on Toni's post.

Thanks for the engaging discussion!

I'm having difficulty reconciling something that came up from a response on the blog I did about Ron Paul's comments.

If we are a society that will allow someone to die as a consequence of their actions/inactions, then why won't we let someone die who chooses to do so when they are terminally ill?

What about the spouse or child of someone who has chosen not to have health insurance? Shall they be held accountable for the decisions of the breadwinner?

There is a remarkable story in today's NY Times

http://www.nytimes.com/2011/10/02/nyregion/stuck-in-bed-for-19-months-at-hospitals-expense.html?_r=1&hp

This article looks at the actions and expense at keeping an undocumented alien in the hospital after a stroke. It is remarkable because I can't even think of how to fix a problem like this. Should the paramedics have asked him if he was insured and then left him on the subway platform to die? Should the hospital have gotten him stable and then shipped him back to China?

This is a discussion worth having. There will be no easy answer. To go back to the simpler days that Ron Paul speaks of has an appeal, but remember that life expectancy was only about 66 years old back then, there would be no MRIs, no CT scans, no statin drugs, and very few lawsuits. Appealing? In some ways, but like the movie "Pleasantville" going back in time can make you appreciate how far we've come.

Great post Janey, it does get one thinking!

Dean,

I appreciate your candor and enjoy the exchange of ideas as well.  I wasn't actually expressing my views, as much as sharing my interpretation of the segment and drawing parallels to what I've read on this community.  So, counter away ;-)  My thoughts, including some of my personal views this time:

1.  Ron Paul's comments were directed at a hypothetical man capable of paying for insurance who made an informed, albeit misguided, choice not to.  His point was that in our current society, this man would expect to be taken care of anyway, should something catastrophic happen.  We've developed an entitlement attitude where we expect to be exempt from our consequences.  In my opinion, neither the elderly man you mentioned nor the Medicare/Medicaid systems fall within the parameters of this hypothetical.  In my opinion, recent events including the bank bailouts support the entitlement philosophy.

2.  I completely agree with you.  There are forces at work that have to goal of keeping us in a state of ignorance.  But our apathy has allowed those forces to get to the point they are.  Whether we arrive at comfort on accident, or whether we rigorously pursue it, the danger of being comfortable is that we grow complacent.  We are reaping the consequences of complacency in many ways.  One of those is that we are content to let the government take care of us.  A fringe benefit gives a nod back to #1, because when we give responsibility to someone else that exempts us from personal accountability.  I believe in personal accountability so it is frustrating to me when others act like it is a foreign concept.  But, Ron Paul describing a time when medicine did not include government involvement was a mental leap for me.  (I think this concept may be fundamentally different than the point you are making-more on that in a minute.)  I have only ever known our current medical system.  To think it could be another way seems impossible.  Honestly, I don't know that the medical model Ron Paul described would ever again be a realistic option.  I rather think not.  BUT, finally I get how so many today, especially the under 30 set can have no comprehension of personal accountability.  It has been all but removed from our society.  Consequences have become an unacceptable casualty.

2.b.  Beyond the mental assent that we indeed CAN take care of ourselves (and as I've said, I'm not sure that is even a true option), there is a matter of priorities.  There are times I have the knowledge, but utilizing that knowledge in a positive way is not a priority for me.  If I choose not to be proactive with that information, I should be responsible for the consequences.  

2.c.  The fundamental difference.  My interpretation of what Ron Paul was saying is that society is capable of delivering medical care without the intervention of government.  As I said, at this stage in the game I am not sure that we can go back to that.  But the concept that it ever occurred was an aha moment for me - making me realize how much I accept without question.  Your point seems to go more to whether or not we have enough accurate information to make educated health care decisions.  I think that is a different discussion.  A very valid discussion, but a different one.

3.  I don't think the competition is in medicine so much as in insurance programs and pharmceuticals.  If I have a PPO, the competition is heavily weighted toward in network providers and low tier prescription meds.  If a medical procedure isn't covered at all, a person may opt for an less desired alternative treatment that insurance pays for.  I wrote a blog a while back on us being insurance consumers, not health care consumers because our bottom line is not the doctor's bill but the insurance's copay.  And to bring in information from your second point, pharmaceuticals is right up there with those who are being selective with information they provide.  Both pharmaceutical labs and healthcare providers play a dangerous came of kickbacks while patients' lives hang in the balance.  I was talking to someone just last week who years ago uncovered a kickback system within a multiphysician/hospital network that had patients going to ridiculous extremes and expenses to get the care they needed.  While I do see your point in that there is competition, I don't think it is a healthy competition focused on patient care, but rather a financially centered competition where patients are incidental.

4.  This last point shows how everything is so interrelated and why it will be so difficult to untangle.  My interpretation of what was being conveyed is that our medical system is now a conglomeration of government (remember, he is still speaking here of the private sector - NOT Medicare/Medicaid), pharmaceutical companies, and insurances.  These three entities interact at multiple levels and drive up the cost of medicine.  At this point, I think Ron Paul was saying, in his perfect world (a world I have serious doubts could exist), these three entities would cease to exist in healthcare delivery.  Obviously, you have to have people making medicines, but they would not have the lobbying power because government would no longer regulate healthcare and insurance would no longer pay for it.  Ron Paul's theory is that when you get these three deep pockets out of the picture, the prices go down making all healthcare far more affordable.  Also, without the restrictions, alternative medicine which already exists now becomes more accessible.  The patient is paying for it...for all of it.  Period.  Honestly, I'm not sure what I think about this.  I'm just saying this is my interpretation of what I think Ron Paul was suggesting.  As far as non-evidenced based...if the average person gets better, does he care if someone has evidence as to why it works?  Would you rather have access to a limited number of treatments - treatments that have been determined by someone you don't know to have passed their criteria for evidenced based?  Or would you rather have access to every treatment available and make your own decision as to what works for you?  I understand that the medical community sees evidence-based care as protecting patients from fraudulent practitioners.  But, it is also limiting the availability of treatments that may be just as effective, but not yet proven.  I'm thinking of Christopher Columbus.  So glad he didn't stick with evidence-based practice.  Oftentimes oversight protects us, but sometimes it holds us back from something good.  This is where TRUE competition dies out.  Only those who pass muster are allowed to compete.  Why does someone else get to decide who gets to compete?  If everyone gets to compete, THEN the phonies will eventually die a natural death.  Meanwhile, those who disagree with these non-evidence based alternatives don't have to use them.  That's the beauty of true, unrestricted competition!

Thank you for making me think - again - and inviting me to grow with the exchange of ideas and information.  Here's hoping others do join in and share their thoughts so we can all learn together!  

Jason,

Thanks for your thoughts.  Interesting separating out children.  I can appreciate the rationale behind that proposal.  However, this could be a slippery slope.  If  parents accept government assistance to provide for their children's medical care, how can those same parents complain if the government wants to make other decisions that usurp the parents authority?  If we will hand over the financial responsibility, what right do we have to retain a moral responsibility?

Medicinal marijuana?  Just this week I was thinking about this - not marijuana persay, but the apparent inconsistencies in our laws regarding illegal substances.  I say apparent because I'm not well versed.  But from an outsider, alcohol and nicotine are addictive substances yet they are legal.  What makes marijuana different?  From a prescription perspective, there are medicines that were prescription only just a few years ago (Claritin, Zyrtec) that are now over the counter.  What makes the difference?  

So, for marijuana there are two questions...should it be legal and should it require a prescription?  

Good points.  My proposal is to provide free health care for children from birth to 18.  And up to 25 years old provided they are in college.  Who pays for this? Me and you, the taxpayers of this country so we can ensure our children are healthy and strong for the next generation.

With two disabled children in my household there are times my net income is not able to cover the health needs of my children even with the insurance I have.  There are tough choices to make in regards to this.  

Is medicinal marijuana included in the alternative health care debate?  Maybe it should be.      

Janey, Thanks for providing a counter point to a recent post of my own. I would like to counter each of your bullet points if I may:

1. Not all our health choices are our own. I know of some older adults who were instructed to smoke by their own doctors in the 50's and 60's . Who is responsible in a case like this? The individual was following expert guidance. Shall we sue the doctors because they didn't know better? I believe we who have paid into a system are, indeed entitled to be able to utilize the funds we have invested in Medicare and Medicaid.

2. I have read Dr Patt's posts about patients not taking medications, about being ridiculously overweight, and I see the empirical evidence of that myself everyday. No, frankly, I don't think the bulk of the population does know how to make informed decisions for themselves. How to address that is another issue. Big business doesn't want us to know if the food we eat is loaded with fat and sugar, if the car we drive has substandard safety ratings, or if our homes have been built on toxic waste sites. All these things contribute to the public health and ability to be informed. Is it reasonable to expect the public to be informed when there are forces at work to misinform them as much as possible?

3. Lack of competition in medicine. Actually, I can't think of a more competitive industry. Drug companies racing to get products to market before their competitors, Insurance companies promising tons of "value added" options to get one's business, hospitals vying to be voted one of the 10 best in the city/state/region/country to get more business. I think competition is alive and doing well in the USA actually.

4. I'm actually on board with alternatives to western medicine. As a matter of fact I have legally paid out of pocket for it in numerous forms. I can't speak for the rest of the country (much as I'd like to) but there was plenty of alternative therapy available in NYC. Are you saying that the government funding you don't want should pay for it? Won't that increase costs? Won't many disagree with these non-evidence based alternatives?

I hope you know that I respect your point of view and that it is clear to me your points are well thought out. Lets have a great discussion on this one and I hope others join in! It is always a growth experience exchanging ideas with you. Cheers, Dean