Health Care thoughts: Reality is Ugly
by Tom aka Rusty Rustbelt
Health Care: Reality is Ugly
An Indiana baby with an extremely rare condition will not be receiving $500,000 experimental surgery at Duke because the State of Indiana cannot afford to pay the bill for the surgery.
The immediate howls of protest are directed at the Republican governor, but there are bigger issues here, and a comparative effectiveness program designed by Democrats could easily come to the same decision.
Stipulated, no one wants to see a baby die. No one. However…..
No system has infinite resources, and if the money was spent it would be care taken away from some other Indiana residents. Even if the economy were better.
On the other hand (as an economist might say) many common procedures were once experimental, that is how new surgeries and new cures are developed.
Fifty years ago this was easier, medicine was relatively primitive and babies died (including my infant cousins) because nothing could be done. Now, we have difficult, terrible decisions to make.
HT: Yahoo News
I usually try to avoid purely political arguments for the same reason I’ve spent the last 40 some years avoiding arguments on religious issues, mainly because they are typically an endless waste of time.
But, in this case, it is difficult to ignore the fact that the Repubs hurt our nation immeasurably by using ‘death panels’ as a political tool. This issue is at the the center of all-things health-care. But it was marginalized for nothing more than political positioning, but people will undoubtably suffer because some insensitive jerk, who was unable to think past some selfish ambition, was allowed to gain some meaningless advantage in the grand scheme of American political nonsense.
“Stipulated, no one wants to see a baby die. No one. However…..”
But it is okay to spend a trillion a year on war!!
40% of US G outlays go to war mongering and corporate welfare, a society that does those things and lets a bay die because it might cost a few hours of flyingtime costs for a B-2 is not worth saving or defending or surviving.
Ike said every dollar taken for the military industrial complex is a dollar taken from the backs of the working man.
Then, the 2008 life expectancy of the US has declined.
The humanity, the opportunity costs of the 40% wasted on the rich.
Well ilsm has beat me to the point. It is only a question of scarce resources if we leave out of the equation the grossly wasted resources of war and corporate welfare. In addition the grossly skewed distribution of annual income results in far lower tax receipts collected by the IRS. And accumulated wealth escapes virtually all taxation. If one percent of the population is going to live like aristocrats then the other 95% are going to have to give up significant comforts of life and even good health. The other 4% are too busy showing fealty to their owners in return for their small share of that wealth.
Not to be too cold-hearted, I hope, but there is an old rhyme:
“Thou shalt not kill, but needst not strive
Judiciously to keep alive.”
In this rare case, there are a number of moral, ethical, and legal questions. But apparently the citizens of Indiana decided those questions for their state, and now, it is claimed, the state cannot afford to carry out its obligations to this child and its family. A sad state of affairs, indeed. These people, and others, suffer because of the imprudence, to say the least, of others, several of whom, instead of paying for their indiscretion, received support from the Federal gov’t with no or few questions asked. This case simply underscores the fact that we should have bailed out the states, as well. Something to keep in mind during the next recession cum financial crisis in 2020.
In this rare case, there are a number of moral, ethical, and legal questions. But apparently the citizens of Indiana decided those questions for their state, and now, it is claimed, the state cannot afford to carry out its obligations to this child and its family. A sad state of affairs, indeed. These people, and others, suffer because of the imprudence, to say the least, of others, several of whom, instead of paying for their indiscretion, received support from the Federal gov’t with no or few questions asked. This case simply underscores the fact that we should have bailed out the states, as well. Something to keep in mind during the next recession cum financial crisis in 2020.
Didn’t all the revenue IN got from turning 80 into a Toll Road and then /selling it off for ten cents on the dollar/ reaping the massive gains from privatizing it make $500K chump change?
The UK is the most militarist state in Europe and it throws a fraction of US outlays for their centuries old war machine. It is 7% of expenditures and declining in the UK while in the US DoD less all the other supports to war profits are 20% plus of outlays.
US spends more than the rest of the world combined on militarism.
Germany, that paragon of saving and banking virtue, spends less than UK as a percent of outlays and while the US in 2011 will have 1.4 million in active duty in uniform the wehrmacht is declining to 160K.
Obsenity is what Rusty is telling.
The case cited is one of the problems with todays complex medical system. We have choosen to play god and extend life. But as is clear world wide the demand for medical services exceeds what society chooses to pay for them. If you have the money you can pay yourself but if you ask all of society to pay (either insurance or medicaid/medicare) some rationing decisions are needed. In this case should we cut pre-natal care for a bunch of women to provide for this surgery, should we put old folks out of nursing homes? Leroy Augustine of MSU forsaw this problem in the 1960s and wrote a book called Come Let Us Play God that covered just this issue, Or for another example should we keep Terrie Shaivo alive because there is a non-zero chance she might recover?
The cited demagoging of the discussion of end of life care applies here as it would have ensured that Terrie’s wishes were known. (Note that this discussion should take place shortly after one becomes an adult, not just at 65).
This is what happens when you leave a common need, the research of life, health and healing to the private sector. It’s worked for decades. A large portion of R & D in Medicine has always been funded via the private insurance system we have for financing health care. Now they don’t want it and because we think other things are a more “efficient” use of funds, research will become the hot potato.
If the private insurance can’t make money off it and we don’t want to pay taxes, well…
Just another example of the rugged individual myth of American economic development crashing against the wall of social life needs.
“Now, we have difficult, terrible decisions to make.”
No, not really. We have different terrible decisions to make, this is true. 70 years ago it might have been who gets the Iron Lung?
Now it’s who does or does not get this $500,000 treatment. but in a world of scarcity such decisions will always have to be made: yes, even if we dismantle the DoD, we’ll just have moved that boundary where those decisions have to be made out a little bit further.
How about Lockheed set up a web site to raise money for the extra two years and 5B to develop the F-35 and the US take care of this kid?
When the war profiteers need bake sales…………………………
tim,
The direct DoD outlays are twice medicare. The direct DoD outlays are about the same as SS outlays.
It is moving the bar about $300B a year if you cut DoD to 25% of the world’s militarism.
When the Marines need to have a bake sale for their 15 years’ late replacement Gator it will be okay.
The new Gator can do what you saw John Wayne jump out of in Sands of Iwo Jima, and also run with the M-1 tanks at 60 kph, followed by each’s own fuel truck. All this delivered by a San Antonio class ship supported by a flotilla, larger than Dewey took Manila with……….
To retake Pellieu Island?
Let’s organize a web site………………. Raise donations!
Thank you MG. A good use of your talent.
Tom (rusty)
and Tim (crusty?)
I am not speaking ex-Cathedra here, just rolling over a few thoughts in my mind.
Rusty is right… terrible decisions to make. Others are right… we could push the boundary for these decisions a little further, maybe a lot further, in the direction of the angels if we were a little more sane (term of art, i’ll come back to it in a postscript).
IF this were truly a rare event, a morally sane society would pull out all the stops and try to save the kid. On the other hand, if it seems unlikely the kid will have a life worth living (subjective measure) a lot of us would face the same choice we face when our dogs get too old for the rest of their lives to be anything but pain and misery.
How much of the “cost” of this operation is because “doctors can’t work for free”? What would be the actual cost if the “experiment” were made on a “charity” basis… hard to do in an economy when most of the tools were made by relatively low wage workers a thousand miles away and years ago.
And how much of the resistance to pay the cost is because we have hardened our hearts prematurely… we’d all rather have that extra bottle of champagne every year, or that new nuclear submarine, or… and the fact is it’s not half a million dollars spread over a hundred million taxpayers that scares us, but just that in general, you know, we have priorities.
That said, if this sort of thing is going to be common, and I think it is, we are indeed going to face some choices. At first they will be unpleasant if not exactly hard. But at the end of the day we will become hard and there won’t be any choices at all that we notice.
p.s.
sane as a term of art.
a few folks on this blog go crazy when ever i call something insane. you have to understand that i am talking about my feelings about whatever it is, not making a clinical diagnosis, or calling for involuntary commitment of the person who just said what i called insane.
it’s just talk, folks. it’s not spitting in your soup. it tells you how i feel. it doesn’t tell you how you ARE. hell, even I am not stupid enough to think that.
except in a few cases. certainly it is insane to go crazy because someone in a blog says that something you said is insane.
and maybe even worth thinking about, if you have the time, why someone would use a word like “insane” to describe an idea or habit of thought. i tend to use the word where a much older generation would have used the word “sin,” but that drives even more people crazy.
there are some ideas, or failure to have ideas, that lead to a persistent state of a kind of sickness, ill health, not feeling good. often these ideas begin as enthusiasm and certainty and are defended with a morally righteous vigour… but how do they end?
Keep in mind the baby could have the surgery, and there are three potential outcomes:
1) success leading to a long and happy life
2) immediate death
3) failure and slow death
Success is not assured.
ILSM:
I understand that just about every single topic here becomes a criticism of the “war machine” but I’m not certain what is being added to the discussion.
Dismantle the entire military and there would still be difficult decisions about the use of health care resources, which is the topic of the conversation.
The refusal of governments (fed and states) to pay for experimental procedures is hardly new.
Even if the doctors work for free there are immense costs to such an operation and follow up treatment. Somehow that cost would have to be paid, if not by Indiana then by redirecting other hospital funds away from some other use.
All courses of action produce only one of three possible outcomes. Things stay the same, get better, or get worse. So, you’re quite right, STR, that success is not assured. From a moral perspective, the likelihood of success doesn’t matter, though. You do the right thing because it is the right thing, not because it’s likely to succeed or fail. In this case, the cost might not matter. The prospect of continuing the suffering of this child only to see him die seems more important to me. I wouldn’t be so quick to worry about the money. They can always call Warren Buffet or the new kid billionaires for a donation. There’s plenty of money in this country. The only question is who decides how to spend it. NancyO
Actually in medicine, and especially in mass casualty and complex illness situations, triage is used based on the likelihood of success.
And for that matter surgeons and patients make decisions every day based on a likelihood of success.
To cast this in a strictly moral perspective misses the complexity.
Look at it this way
suppose the kid was trapped in a mine.
how much would we pay to rescue him?
suppose a kid was trapped in a mine every day.
how much would we pay to rescue them?
“to cast this in a strictly moral perspective misses the complexity.”
by complexity you mean money.
and while i have to agree that it’s a hard question, and one we may not like the answer we give to ourslves, it is a moral question.
“The refusal of governments (fed and states) to pay for experimental procedures is hardly new.”
Well, then, why is there a question of the state of Indiana not being able to pay, if they do not have an obligation to pay?
And, for my information, since I do not follow these things, if the procedure is experimental, why does it cost so much? Don’t they have a grant? If not, why not?
Medical schools and research schools have huge humbers of grants at any given time, but primarily for the research that preceeds the treatment – and it depends on the type of research.
The is a moral element, it is not strictly a moral question.
I object to the opening paragraph:
“An Indiana baby with an extremely rare condition will not be receiving $500,000 experimental surgery at Duke because the State of Indiana cannot afford to pay the bill for the surgery.
“The immediate howls of protest are directed at the Republican governor,”
Under protest, I have read the story online. There is nothing about the state’s ability to pay in the story. Relevant quote:
“Seth’s parents, Becky and Tim Petreikis, of Dyer, quickly learned the procedure isn’t covered by their son’s Medicaid, and their two appeals to the state’s Family and Social Services Administration have been denied. Petreikis will need the shunt in his heart replaced by February, but he can’t have the surgery done unless the Complete DiGeorge syndrome is addressed first.
“It’s like he’s been sentenced to death,” Becky Petreikis said.
“Marcus Barlow, a spokesman for the state’s FSSA, said the procedure, called a thymus transplant, is considered experimental and therefore not covered by the state’s Medicaid.”
Apparently, “experimental” in this context means “unproven”. Some states’ Medicaid covers the operation, some do not, according to the story. It is hard to say that things are not working more or less as they should.
coberly:
“How much of the “cost” of this operation is because “doctors can’t work for free?”
I have heard of an M. D. who would occasionally propose an experimental treatment to a patient, and then **pay them** if they accepted. That’s the ethical way, isn’t it?
Well, certainty of success doesn’t have much to do with people who want every possible procedure used to prolong the life of a dying parent, spouse or child. The outcome is known and the expense is enormous. I would argue that needlessly prolonging the life of a loved one is not right since the decision is more made for oneself than the dying person. Still, Medicare pays one way or another. So, the act follows the decision which is a moral one. However, in reality, it’s a matter of money, more likely than not.
min
sounds fair, am i missing something?
i don’t propose that doctors work for free as a general rule. i do think that always valuing money over any other consideration is a sickness.
thanks min
i had forgot that what you’re liable to read in the news ain’t necessarily so.
I believe that only two of the operations out of sixty performed at Duke resulted in babies’ death. You can look that up.
The probability is high that the operation will be successful according to the lead surgeon.
Min,
You are quite correct. Some other news stories out of the Chicago area were written very similar to the local article. The surgery, according to a Duke University surgeon, is in the range of $350,000 to $500,000.
There was no link to the Yahoo story, so who knows what it said.
rusty
i wonder if you are thinking “moral question” means there is only one answer. we have to do the”moral” thing. i don’t think that’s what moral question means. it means our decision turns on where we are willing to draw a sort of line between have to do, and can’t do. but all those “complications” you speak of are just part of the moral question.
doesn’t really take away the moral issue raised here, however. whether this case is an example of it or not, it is something we are going to have to face.
as to what is a moral issue, i think i’ll leave that as an exercise for the class.
This is an example of my continual question for our lefty’s and health care. Where do you draw the line? Or how I usually state it.
“When does poor grandma die when rich grandma can write a check and live 10 more years?”
You won’t bend the health care cost curve down if you say there is nothing the state won’t pay for.
Islam will change
I have worked through two end of life cases aged parents in my “family” in the past couple of years.
One was hospice, a rational decision. Relatively cheap, painless and dignified.
People with lesser “resources” in my experience go hospice.
The other was 4 months in ICU one reprieve to “step down” but returned. Very expensive, painful to watch, but the patient had choice.
Now I understand that Palin had an issue with “death panels” when the propagandist righties were against attempting to break the medical insurance cabal strangle hold on Medicare, medicaid and the middle class in general. The idea of judging treatments on resources may or may not have been in that FOX news cluster bomb of sensitivity for the medical insurance cabal.
I don’t know why the lefties got painted with “death panles” maybe you can explain.
But, in decisions of life or death the role of the patient or medical decision maker might or might not be a solely resource decision.
But I do not know why Palin was against death panels, other than as a speaking point for the medical insurance cabal .
None of them are for taking money from militarism to ease the resource issues.
It is one pillaging profit scam the military against the medical industry complex.
And the decline in life expectancy in the US in 08 is from that.
So, I cannot answer for the lefties but I want human dignity for 100% not just for 3% of the US.
http://www.huffingtonpost.com/2010/12/10/seth-petreikis-surgery-ba_n_795315.html
Speaking of the case in issue–The insurance company is paying for the surgery. See above link. Well, go figure. NancyO
MG:
Generalizations without knowing the detail
Why so expensive?
Nowithstanding the issues of morality. Didn’t the state already spend money to prolong and improve the quality of life of this child?
Not knowing the specifics of this case, I would like to make a generalized statement. Americans tend to be generous, willing to spend money resources for hope even nothing less than a miracle will cure a disease and/or problem in the society.
This child already had congenital heart disease staged repair. Looks like they are at stage I or stage II of repair. Did anyone asks how much money already been spend and how much additional money will be spend on these life prolonging procedures? This baby would have probably been in the neonatal intensive care unit when born then most like a “BT” shunt, may be a “glenn” shunt followed by “font an” if this baby eneded up with a single ventricle physiology.
The article got caught up in the typical frenzy “this experimental, unapproved will cost 500000.”. This baby had cost the state easily more than 500000 already and will cost even more; probably 2-3 million in the next few years.
Sometimes medical problems, especially one looks from outside, can be described as keyhole syndrome… How can you tell what’s in the house when look through a keyhole? What happens when you decide to open the poor(I.e. The proposed experimental surgery). What do you discover when you finally walk into the house. Is it livable, does it have water, electricity?
This is the reason medical problems ca be complex, and ended up costing astronomical amounts of money…. Is it better to buy a brand new house, buy a well maintained old house, a condo, or roll a dice and buy a house from an auction? Unless we can cure death, I think we need to look at cycle of life, what is it worth to you? Is it better to live a life as good as it gets/can be? Or ask society to do everything they can to stop the cycle? Quality of life verses do everything we can? The answer is different for everyone…. But there’s always reality!!!
The Insurance just make everyone happy… But I think everyones taxes and insurance rate just went up a notch…
Weeks if not months of post operative intensive care (probably). Extremely expensive anti-rejection medications. Highly specialized nursing staff 24/7. etc.
PR–The money is a sort of proxy for the futility of extending medical efforts beyond reason. I think this happens because people don’t have a clue how long this can go on. Just watching modern medicine at work is gruesome. Being in the bed is worse. Unless you’ve already experienced end-of-life scenes, it’s impossible to imagine how bad it can be.
The idea of saving their children works powerfully on parents. But, I am thinking that it’s as much ignorance as anything that keeps such processes going on beyond reason. After every procedure, there’s an expectation of finality. Now, everything will be alright. But there’s always more. Someone will offer another procedure and so on. It’s the “so on” that gives rise to these conversations. NancyO
rusty:
So sunk costs are the cost of this procedure? Nurses on staff? Highly expensive ant-rejection meds already paid for multi-times over Months of post operative care?
I paid twice for a cardiogram, once to the doctors office and once to the hospital at U of M. Do you think those fees were set aside to buy a new? I suspect the high cost is the profit motive of the medical industry.
I’m confused by people’s interest in this because for every sick baby that makes the news, many more die for similar reasons. No matter, it does provide a picture of our strange society.
We provide a lot of money to research “cures” whether it be public, private or charity. Then the “cures” provide a moral issue because “cures” are not cheap enough for our society to administer to the public. (Note, before the cure is available, there is no moral issue at all.)
We chose to live in a society that is fashioned around services for those that can pay. Then we get upset when our society simply plays out as we have fashioned. If we insist on a society such as we have, then cost/benefit reins when private wealth isn’t there to pay.