Conference rdvax::grateful

    oh yeah...  to tie this in to the Grateful Dead...  let's say you were
    at a concert and were injured, dosed, sick or some such thing...
    you are taken to the hospital without id, health coverage info, etc...
    should you expect to be treated?  or should someone have the right to
    deny you treatment since "it was your choice to do drugs/attend show/
    behave in such a fashion" etc...

    
    hey DWEST,
      I just want to say "amusing way to make sure it is tied into the
    dead in some form or fashion".  made me chuckle. 
    
    	Mark

    glad you liked it Mark...  we aim to please...
    
    we don't always hit, but at least we aim...  :^)

As a former smoker, I think people choose to smoke in the same sense
that they choose to be addicted to heroin or cocaine.  C. Everett Koop
even went as far as to compare the addictions as equals, and I can see
why.  No one sets out to become addicted, and few enjoy it in the long
run.

I think smokers should be treated in the same fashion as heroin addicts,
because basically, they are.  They're nicotine addicts.  I don't think
you can enforce non-smoking any more than you can effectively enforce
non-drinking or any other recovery from an addiction.  Cigarettes are
just another form of substance abuse, and abuse that leads to addiction
is, in itself, a health issue.  You can't force people to stop their
unhealthy habits...

Otherwise, the government is going to have to start ticketting people for
not using a condom....but only if they get pulled over for something else...


Sorry, but I couldn't resist that one any longer...;-)

tim

    i agree that cig smokers are addicts as well...  
    
    "hi...  my name is da ve w. adn i'm am a nicotine junkie"...
    
    supposedly, the addiction is as bad, if not worse, to kick than heroin!
    i know it took em a long time and lots of tries to quit...
    
    also, while i agree that no one (no one intelligent anyway) CHOOSES
    to become addicted, there is still a choice to begin the behavior
    in the first place...
    
    so it still begs the question i was getting at in the beginning...
    if non-smokers (or people who practice some other "personal choice"
    beheavior that may be health threatening) and smokers are in the same
    health plan, should the smoker be denied any level of health care
    based on the fact that it was the result of a "chosen" behavior???
    
    i was getting the impression that several folks feel that they
    shouldn't have to contribute to those types of situations...  
    sort of an "i don't smoke so my money shouldn't be used for your lung
    cancer surgery" or whatever other treatment may be prescribed...
    
    yea or nay???
    
    sticking with the analogy of smokers being similar to junkies... 
    should money be provided from public/private coffers to treat these
    folks???  bare minimum treatments?  best available???  after all,
    it is a "choice behavior"...  if you don't approve should your
    contributions have to support these kinds of things?
    
    					da ve
    

    
    well here's an answer (since you really seem to want one! :-)
    
    No.
    
    Who decides which choices are good and which are bad?  Who sets the
    limits?  Who draws the lines?  etc. etc.
    
    If I choose to eat red meat do I not get coverage for a heart attack?
    

da ve, my general feeling is that no one should be denied health care
for any reason.  My but... comes in with, part of health care should 
also be education about possible problems that arise due to things 
we choose to do.  Certainly we've seen this all over the place with
regards to smoking.  I think someone else mentioned that some people 
get cancer, and others do not, given the same diet, cigarette abuse,
etc.  Lord knows my mother, now in her seventies, has been smoking,
probably since her teens, and the largest problem she's had has been
a bad back.  When we were growing up, she exposed us to a lot of 
second-hand smoke, though now-adays we force her outside ;-)
(I wonder, though don't go so far as to blame, if my respiratory allergies
and such problems might be related).  
  I think that once a problem is identified, and a smoking gun points at
cigs, or alcohol, then steps should be taken to modify the behavior
so that it does not worsen the problem.  Of course, often it's too late
to do anything realistic.  I've heard that over in the UK, some hospitals
have taken the stand that smokers have caused their own problems, and they
will not treat them until they modify their behavior, but in some cases
it seems too harsh a stand to take.
  Now if you want to put an extra tax on cigs and alcohol, to help pay
for health care, as they may be a part of the problem, well, I don't
really have anything to say against that.  Seems almost logical, but I'm
sure there will be protests.

PeterT

re    <<< Note 392.0 by STRATA::DWEST "choose wisdom over intelligence..." >>>
                -< personal repsonsibility, health care etc... >-

>    1.  does an enlightened, technologically advanced society have an
>    obligation to provide health care to its citizens?
 
i think so, but, the extent of the publically provided care _must_ be
limited - if john doe is on the death bed and machines are keeping him
alive at the cost of $20,000 a day, i don't think the public system should
pay for that.  however, if some person wherever fell and broke their ankle,
that should be covered.  there seems to be quite a bit _unnecessary_
health care provided today;  i in fact once was nearly "over cared" for at
a hospital in NJ while in college.  this is what needs to be stopped!!!  
in the WSJ, there was an article talking about car insurance and the limits
set on how much care is paid for by the insurance co.  the article went on
to assert that doctors prescribe/perform care on people _that_is_NOT_ needed,
because they know where the $ limit is, and if they don't go up do it, they
don't get paid by the ins. co (i may not have all the details straight, but
the jist is: unnecessary care!).  chiropractors (sp?), the article asserted,
are the biggest ripoff doctors in car related health ills ("my back, my back!").

now, the hard part is, who draws the line betw. unnecessary and necessary?
that, i assert, is a difficult task.

>    2.  does an individual have the right to expect the best available
>    treatment for thier illnesses without regard to thier financial
>    situation or "personal lifestyle choices"?

my response to #1 covers this question quite a bit.  but, in the case of
no seatbelts or no helmet worn and the person smashes their head up, i
have to ponder that one.  perhaps if the health care is gov't mandated, the
govt can set the rules on this stuff.  it is pretty clear-cut with seatbelts
and helmets, however, with other "bad" things like cigs, alc, red meat,
it is definitely much more difficult to attribute to the bad thing...  i
don't really know how to strike a balance there, but i believe accountability
needs to be factored in somewhere.
   
>    3.  does anyone have the right to refuse health care to individuals or
>    groups because they personally do not support the choices that
>    individual made in her/his/it's life?
 
similar response... yes, but if you clearly are acting in a totally
irresponsible way, you're irresponsibility puts a financial burden on
the public care, so perhaps some people should be denied.  is this fair 
to others who act responsibly???  where is one accountable in a "no questions"
asked system (ie: everyone gets care no matter what)?  mostly, i'm talking 
about the seatbelts/no_helmet stuff, not the cig, alc, etc stuff.

In the context of a 'national care system' (as da ve so prefaced his
questions, disclaimer or no disclaimer :-), I'll ask the following...

Should national health care be:
    - 100% preventative, 0% corrective?
    - 50% preventative, 50% corrective?
    - 0% preventative, 100% corrective?


So I'll begin with the easy one...

>    3.  does anyone have the right to refuse health care to individuals or
>    groups because they personally do not support the choices that
>    individual made in her/his/it's life?
 
Nope.  You can't limit choice.  To do so violates our Constitution.



> 1.  does an enlightened, technologically advanced society have an obligation
>     to provide health care to its citizens?

Yes, absolutely:   Our society should take care of itself.  Now, there appears
to be a cost/benefit problem in our every-modernizing society.  We perceive
our helth care system as having too much cost and not enough benefits.  But
fixing this problem is a tricky subject, and it brings up a conflict between
humanistic 'values' and economic 'realities.'


So here's my case study... I'll use the recent technological advancement of
Magnetic Resonance Imaging (MRI) as an example for discussion.

By investing in medicine technology, our society is allowed to take 'better'
care of itself through technological advancements.  I think we can all agree
with this.

The problem is that the advancements require investment -- either up front or
after the fact in debt-payoff.  With technology such as MRI, we're now much
more capable of early detection of cancer (among other uses), which
drastically increases the cure rates in many cases.  Clearly, society can
benefit from this if society has access to this.  But the cost of developing
and using MRI technology is astronomical (million dollar machines, etc.).  

Our society's economy is based on free-market principles.  And the free-market
values of our society say that you can have access to this technology if you
can afford it.  The problem with our current society is the concept of
insurance -- shared costs.  

Average basic health care premiums have to be able to cover high MRI costs for
everybody, even though everybody can clearly not afford the technology.  Why
does this happen?  Doctors are afraid of getting sued for malpractice --
erring on the side of 'not enough care' is negligence according to our legal
system, and our legal system requires 'too much care' in most cases to avoid
liability in the event of litigation.  So doctors will tend to suggest MRI
treatment, and run up the cost of 'basic' health care, since to avoid it is
negligence.

This is the problem that I see with health care.  The concept of 'cost' has
never entered into the decision making process, nor into the litigious
process.  If the individual is left to pay for her/his own MRI treatment, then
they shal make the choice to use it or not to use it, and then the burden of
liability should align itself with their ability to pay.  Fair?  Perhaps not,
but it's the way of the free-market.  To guarantee 'cost-is-no-object' health
care to a society that can't afford it is foolish, and will have disastrous
economic ramifications.  

Cost MUST be included into the health care process if 'health care reform' is
to succeed.


>    2.  does an individual have the right to expect the best available
>    treatment for thier illnesses without regard to thier financial
>    situation or "personal lifestyle choices"?
 
Financial situations and personal lifestyles are guaranteed choices in our
society.  You can choose to be rich, and you can choose to be poor -- or do
something about your poverty (welfare or no welfare).  You can choose to live
your live as you wish (with farily few limitations compared to other real
Earth-based societies).  I don't think these are issues that matter.  They're
given facts that have to be dealt with, not controlled.  


So we need a definition for 'best available treatment.'  This is tricky.

    * Does 'best available' get defined in terms of ability-to-pay?
    * Does 'best available' get defined in terms of technology?

Most folks choose the latter definition -- "MRI exists, therefore I should
have access to it."  Fine, but can you afford $300/image it if it's not
covered by your insurance?  For most folks, the answer is no.  

But today, things like MRI are covered and insurance rates are high.  So
society wants lower insurance rates without wanting to give up access to MRI?!
It just doesn't work.  Ya don't get somethin' for nuthin'!!!

With the normal, individual primary physician care (i.e. expensive health
care), *WE* make the decisions with our physicians.  This is the most 'free'
system, and also the most expensive -- you have to pay for your freedom.  (to
anyone who believes that this HAS NOT ALWAYS BEEN TRUE, I got news for ya...)

To reduce our costs as individuals, we have things like HMOs that offer lower
rates than 'normal' primary-care-physician-health-insurance, and we (as HMO
members) trust the HMOs to make the money-vs.-care decisions for us.  Some
folks (like myself) can live with this -- more disposable income traded off
for less medicinal freedom.  

With federally managed care, we will be trusting our federal health care
agency to make these decisions for us.  It has yet to be determined as to
whether there will be a cost/benefit tradeoff and to what degree it will be
better or worse than the current HMO system.  (Who likes this idea?!)


My idea?  Itemized insurance on a yearly premium basis.  You name what you
want to be covered for (similar to auto insurance, all prices are guesses):
    Basic preventative care (periodic checkups)
        - 2 visits/yr for each adult                            $20
        - 6 visits/yr for each kid (innoculations incl.)        $35
        - family prescriptions (<$1/pill free, you pay over)    $20
    Extenced preventative care (diagnostics, blood tests, etc.)
        - access to MRI, other expensive 'diagnostics'          $10
        - all prescriptions (no $ limits)                       $10
    Catastrophic corrective care (emergency room stuff)
        - bills under $10,000 per occurance up to $100k/yr.     $40        
        - bills covered (regardless of cost)                    $100

You decide what you want to be covered for, and you pay for it.  Very simple.
If you need catastrophic are and you haven't paid for it, then you get what
the government decides you get... ...and you probably won't like that --
waiting in lines, bad treatment, etc.

If the government wants to 'guarantee basic health care for everyone' then let
them pay for the first section.  Frankly, that's all they can really afford,
IMO... ...and my bet is that thats what we'll get.

The 'haves' will still be able to afford the more expensive (and 'better')
treatment through private health agencies, and the 'have nots' will just get
their primary care, and a _form_ of socialized catastrophic care.  You can
forget about the middle part for the 'have nots.'


- jeff

Jeff, a very coherent and well thought out note, thanks for entering it.

Geoff

    some innerestin' stuff coming out now...  :^)
    
    i think that preventive care (ie health maintenance) is cheaper in the
    long run than only providing emergency services for people...  however,
    emergency services also need to be addresed becasue there are always
    people that won't go to the doctor regularly for whatver reason, as
    well as the fact that traumatic stuff  sometimes just happen with no
    warning (which is why they are "emergencies" i guess :^)...
    
    so based onthat i think a national system would have to address both...
    
    the problems Jeff point out about drs running up the bill due to fear
    of lawsuits, or just because they can, are very real...  
    
    as for "best available treatment" being determined by cost or by
    available technology, i guess it has to be both...  the technology
    shoudl be available to people that really need it, but thre shoudl be
    some sort of sane proicess involving the physicain and the patient
    (or the family if the patient isn't capable of participating) that
    determines the appropriate treatments...
    
    as for legal stuff, i definitely support caps on what people can get in
    liability cases...  in medical mappractice cases and the like, thre
    should be a limit on what sort of fiunancial damage a patient can
    recieve...  also the pysicina, if found to be at fault, shoudl have to
    face some sort of disciplinay board (primarily of peers)...
    
    as for the mecahnics of the system, i envision something along the
    lines of the government agreeing to coninue coverage through existing
    systems...  something llike this:
    
    	someone starts working and "enters the system"... (say, i start at
    DEC)...  payroll deductions start and the person is enrolled in the plan 
    of their choice... (say i choose Fallon Clinic) a portion of thier premium 
    goes to a national system... (extra$1/week?)  level of care appropriate 
    is determined by the dr and patient...  should the employee lose thier 
    job, the natl system guarantees continuing premium payments to insurer 
    org...  (i get laid off, but i get to keep insurance cuz the money paid
    into the natl system continues my premiums)...   eventually, i weill
    find new work and continue my insurance coverage, making payments
    like before...  people get to continue coverage of thier choice,
    even if they lose thier jobs...
    
    	employers, instead of making routing payments to the health care
    providers, make ONE payment to sign up with a particular provider,
    and make insurance payments to the natl system as well...  that make
    sit easy for employers to let thier employees choose which plan they
    wat without having to regularly "subscribe" to lots of differnt
    plans...
    
    	people who have not "entered the system" by joining the work force
    adn selecting a provider of thier own could go to a govt run clinic
    that provides care...  a lot less choice (in terms of personal
    physician and such) but treatment can still be made avaialble to
    everyone who needs it (though in this pat of the plan you may have to
    wait longer for services, clinics may not be as pretty, not as much
    "personal service", level of care may be a little less etc...  but it's 
    free and available for anyone who needs it)...  clinics might even be
    stafed by people who are working to pay off govt education loans and
    such (as in CLinton's nat'l service plan)...
    
    everyone gets the care they need...  no judgements on thier lifestyles
    etc...  what is "available" would be determined by combining technology
    available with funds available...
    
    don't know if it would work, but that's what i envision neway...
    
    					da ve 

>    	someone starts working and "enters the system"... (say, i start at
>    DEC)...  payroll deductions start and the person is enrolled in the plan 
>    of their choice...

this is something i don't understand.  why is your insurance tied at all to
your job?  that automatically complicates things for people who work for
companies that don't wish to provide insurance, for students, for people out
of work, etc.

instead of having payroll deductions and employer contributions, i think having
it funded thru taxes would be a much better solution.  plenty of countries
have socialized medicine - why do politicians seem afraid to even discuss it
in this country?

- rich-civil-libertarian-socialist-at-heart