When Do We Say ‘Enough'?

Great discussion.  It is indeed frustrating to provide care that is effectively spat upon by the receiver of that care.

This debate has come up over the years in different ways in other posts.  We've become a society that expects others to do for us.  One of the areas this is seen is in pharmacology: there is a medication for just about everything, even those ailments that could easily be reversed by conciensious personal health care decisions.

Your point about arbitrary caps is well taken.  That's taking the easy way out.  Not all smokers get lung cancer or COPD.  There are people who have lung cancer or COPD that have never smoked.  You punish the innocent with any cap.

Here is another consideration.  If you have 2 two-pack a day smokers x 20 years and one is sick and the other is not, there has to be another factor at play.  So, you could say even those who get sick doing a harmful activity are victims of heredity.

We used to have free wellness visits, now they charge for them.  Where is the incentive to go in and stay healthy?  Why should I not save my money until I "really need" health care?  I think we took a step backwards with that move.  If wellness visits and tests were free, more illnesses would be caught at early stages, saving money in the treatment of more advanced disease.  There could also be an incentive to routinely making well visits and adhering to the doctors' suggestions.

Darren and I were talking about healthcare delivery today and some unique options.  I think the answer to your question would be a complete overhaul of the system, one that would turn conventional healthcare delivery on its nose.  I think it would require a Cameronesque approach - changing the culture so it demands a change.  Perhaps we are on our way.

The challenge that will be inherent in any overhaul, whether it be medical delivery or immigration or taxes, is what to do with the interim.  There has to be a transition that deals with those entrenched in the current system.  I think in all of these situations, we get paralyzed in our thinking when it comes to the transition so we just throw our hands up and stay the course.

Perhaps physical therapy organizations could think of several diagnosis (prognosis) they will deem nonemergent and perhaps refuse to treat after three session with no improvement.  

I appreciate the thought of why treat someone who is self destructive but if we do not treat are we modern day Kervokian adovocates with state authority to allow deaths by non treatment.  

Or should we try to save lives and ease suffering by any means necessary?

Great post and discussion Dean.  

Jason, many people on Medicaid use the ER as a primary care option. It is a VERY expensive option. There are programs, unfortunately aimed mostly at the frail elderly and not universal, which promote care management and primary care which have done well to improve outcomes and reduce costs in New York. Simply not treating someone to reduce costs seems really poorly thought out.

Most children don't suffer from COPD or have strokes due to smoking, drinking and overeating. Children are also lacking capacity to make those decisions so denying them treatment is not part of my question. However, by continuous cycling through the system of those who are unwilling to take any action to improve their own health only depletes the resources available for people like the parents and children of whom you speak.

The chain smoker with COPD who has recurrent chest infections and hospitalizations is the one cavalierly using up the funds. The money simply isn't there to treat everyone for infinity, not even here in the UK and NHS. So yes, there will be suffering ahead. I suppose my question is, who should bear the brunt of it? How will it be decided who gets treatment and who doesn't? Arbitrary targets and caps are not a good way to approach anything. There was a crisis here in the UK for that very reason, the Mid-Staffordshire Trusts caused many deaths by adhering to strict (but meaningless) caps. The hospital has now been shut and all the staff is under legal and professional scrutiny.

So what will we do?

Washington State is limiting Medicaid patients three visits to the ER.  The fourth visit they must pay for.  The state wants to save money.  Physicians worry about patients self diagnosing themselves.  Washingtons Health Care Authority created a list of 700 non-emergent diagnosis not endorsed by physican groups.   Lots of children use Medicaid in Washington State.  Is non treatment an option for those who are suffering?