Posting those Healthcare slides has given me a lead into something I started early in the year when the topic was hot. The posting of pointed thoughts and questions about healthcare cost, and our own contribution to the escalating problem. Here is the background:
G2A USA Spending Priorities
G2A Healthcare Cost Control 1
G2A Healthcare Cost Control 2
Today's topic: The weakening of the Human Race and the Growth of Long term Care Costs...
Darwin's Evolutionary Theory is based on Natural Selection. My simplified definition is that the weak or those no longer suited for the changing environment die. And the strong or well suited to the changing environment, live and propagate. So what happens when modern medicine is used to unwisely prevent natural selection?
I propose that we pull many babies, kids and adults back from the natural course of things and subject them to a life time of care centers, nursing homes, group homes, etc. The cost of which is carried by society. With this in mind, should we "save" everyone that we can?
Now let's compound the problem. The weakened human is not institutionalized, yet they require significant healthcare. Then they choose to propagate, thereby passing along and spreading the genetic defect. Thereby growing the population of those that require extensive healthcare intervention. With this in mind, should we "save" everyone that we can?
Stop and think. How many kids, adults and senior citizens do you know that have a low quality of life and are driving up the cost of healthcare?
I had a ~95 yr old Great Aunt who was ready to pass, she had lived a full life and could no longer get around. She was ready... Yet a nurse tried to convince a family member to use heroic measures to save her when she got sick. Thankfully the family member held their and my Great Aunt's ground. Enough is enough... You may want to make sure you have a living will in place, or they will turn you into a zombie...
Of course it gets harder with younger people or when it your friends/family, however the situations are often similar. Now as usual, I do not have an answer. What are your thoughts on the topic? When is saving someone a really BAD idea? Who should make the decision? Who should bear the cost of the BAD decision?
Now on the lighter side. Movie Trailer Movie Trailer 2 Stunt1 Stunt2 With this in mind, should we "save" everyone that we can? Do we want these people propagating? And do you really want to carry their healthcare costs?
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18 comments:
Careful, you're going to be accused of supporting death panels.
I won't get into the whole idea of weakened human condition and unnatural selection because I'm getting get a strong whif of full-on eugenics, and we've gone down that path (see Bell v. Buck).
However, there are practical ways to look at this.
I think we need to adjust our view of medicine as something to improve but not necessarily prolong or invent life.
I think we need to have a hospice system as strong as our hospital system; help the terminally ill with a path to die with comfort and dignity rather than live with pain.
Infertile couples can have babies, and that's truly a blessing. But when the decision comes to have 7 with severe health problems or one healthy one, there's a hard conversation to be had about the ethics of both the fertilization and the birth.
And I totally agree on end-of-life planning. I'm, hopefully, 50 years from my funeral, but I have a living will and a healthcare directive to prevent any heroic measures in the meantime. Nobody wants to end their lives on ventilators and feeding tubes; a strong public information campaign could help people make that decision for themselves, in advance.
--Annie
For those as unread as me...
Bell vs Buck
Eugenics
Rationing care
Death panels are already in full force. Typically those who have money or good insurance live... Many of those that do not, die...
Wouldn't this just be changing the criteria? Instead of wealth, the criteria would be the individual's "quality of life" and "value to society"? Now, what would be the criteria and who would make the choice???
We do want lower cost healthcare, don't we? And it looks like Buck vs Bell has made it legal...
Buck Ruling Stands
A question hit me as I was driving. Is there a significant difference between active and passive in this case ???
If medical treatment is withheld due to the likely future quality of lfe or cost issues, is this a Death Panel? Or does a Death Panel only exist when they take action such as euthanasia or forced sterilization?
Is withholding care simply saying "Let God's will be done" ??? And if a miracle occurs... It must have been meant to be...
Food for Thought:
Growth Curve 1
Growth Curve 2
Gap Minder 2010
Looks like we are winning the war against natural selection. To what end? That curve is pretty incredible.
I think you're focusing on the hardest questions when there are some easier ones that would ameliorate the problem.
I wish I could remember the exact statisitic, but an astonishingly high percentage of all medical care dollars are consumed by people in the final six months of life. The tests and surgeries and intensive care are often easily into the six figures. And to what end? An 87 year old man with diabetes, congestive heart failure and high blood pressure may also have a bad hip, but is it sensible to put his body or his pocketbook through the trauma of replacement? But doctors are generally (and sometimes barely) trained to talk with patients and families about how to prolong life, not conclude it. The choices that surround end-of-life and hospice are often outside their professional vocabulary.
If you're interested in the topic, the NYT did a very good series last year that delved into end of life care costs, palliative care, end of life sedation and other topics that are very hard to discuss. http://topics.nytimes.com/top/news/health/series/months_to_live/index.html
Remember, in the past year there was a proposed legislation that would have helped doctors and patients talk about their wishes for end of life care--which seems so common sense to me--and it was hijacked by politics. How can we not get behind such a practical and important proposal?
--Annie
Sorry, that NYT link was bad: http://topics.nytimes.com/top/news/health/series/months_to_live/index.html
I think your argument from Darwin is soiled. First of all the practical: Survival of the fittest isn't driven by who lives longest, but who breeds the most. This is particularly noticeable in species like bighorn sheep, where the strongest males win all the fights, breed with all the ewes, and then die because they didn't eat enough to get through the winter-- they were too busy passing on their genes. Most of us easily live longer than it takes to procreate. Unless you're willing to engage in active eugenics to suppress breeding of "the poor" you're not going to change much.
Second, the anti-Darwin: The value of life is not set by you, or me, or the cost of our care. Life is sacred and its value is priceless. It's a gift and you and I have to value it as our other gifts permit. We may not all be ready for death, but we shouldn't be rushed by anybody.
Third, and related but mathematical: we know that the vast majority of medical costs occur in the last six months of life. That's almost certain, given the high-tech care that modern medicine makes available. But what is the certainty that any given procedure will occur in the last six months of life? My own father went in for heart surgery at age 80. They weren't certain he could survive it at his age, and were almost certain he wouldn't live past 85, even if the surgery were sucessful. He lived a full and happy life-- went back to work and travelled the country-- until an "untimely" demise at age 87.
My advice is to keep the government completely out of it, in all ways and in all things. Health care costs should be "controlled" by those receiving and providing the health care, and no other. If someone chooses to contract for insurance, that is their affair ONLY.
J. Ewing
@J--"My advice is to keep the government completely out of it, in all ways and in all things. Health care costs should be "controlled" by those receiving and providing the health care, and no other."
Since the bulk of expensive care involves those on Medicare, isn't the government already intrinsically involved?
Here is Annie's NY Times Link
Though I find the old folks some what interesting, they are not the crux of the topic.(ie no pro-creation in their future) Let's pick a very sensitive topic and see what happens.
A woman/couple chooses to pursue their career/wealth first, therefore they delay pregnancy until later. At 38 years old they choose to have their first child even though they know the odds of the child being born with a "defect" are significantly higher than if she had been pregnant before 30 yrs old.
Should society allow this? If the child is born with Down Syndrome, should society carry the cost of special ed, disability payments, etc? If possible, should the kid be free to procreate?
Older Moms and Birth Defects
Older Mom's and Autism
Why do we keep using words like "we" and "society" (as code-words for government) and then asking what role "we" have in providing someone else's health care? The simple answer is that "we" and "society" don't have a role in someone else's medical and life decisions, unless they are adversely affecting the rest of us, in which case "we" pass a law making it illegal for them to harm us in that particular fashion.
To your example, since it isn't illegal for a 38-year-old woman to conceive and birth a child, it is absolutely nothing that "we" should have a say in.
Apply the same logic to Medicare, please. Turn Medicare into private medical insurance, and government then has no say in who gets what care, end of life or otherwise. The whole health care "problem" is CAUSED by government interference in the free market; the solution is to get government OUT. Simple but not easy.
J. Ewing
I only use WE because currently WE will pay for the INDIVIDUAL's choice. Be it through higher insurance premiums, social security payments, etc.
I used the 38 year old couple because it is likely something my readers can relate to. We all know and care for folks in the situation I described. Typically these questions are posed using couples/Moms that take part in high risk behaviors. (ie drugs, alcohol, smoking, etc) It is typically easy for US to point fingers at THEM. The reality is WE all contribute to the healthcare cost problem.
Now, who is going to pay the private insurance premiums for the low fixed income retired folks? Or do they not have insurance? Do they just come into the emergency room or die off?
That's why I said the solution was simple but not easy. Government currently controls 50% of all health care spending. Government health care inflation is twice what private health care inflation is, so the obvious way to contain cost is privatize all of it. Better yet, hop into your wayback machine and keep government from ever getting into it in the first place.
The problem with "we" is that "we" mean "government," rather than we individually and collectively. We in that communal sense aren't going to let old and poor people suffer unnecessarily; we care and we'll find a way. Government, however, can mandate that we throw money at the problem, but not that we care. Which do you suppose works better at keeping costs down and quality of care up?
Here's what I mean: Suppose we took what is now spent on Medicare, and simply gave seniors the money, to buy private insurance? Costs would go down, or not go up as fast, as I've previously noted, while care would doubtless improve. THEN we could take the Medicare Trust Fund, and pass THAT out to everybody (based on age and what they've paid in), and let them start an HSA for themselves. The hidebound rules and "death panels" of Medicare would cease to exist, and that's a good thing.
J. Ewing
I think you are looking at the past through rose colored nostalgic eyes. My guess is that part of the incredible population growth curve is because governments did take over ensuring that people did not starve and that they got some medical attention. (ie forced wealth redistribution) So, I am not sure that people are/were as charitable as you believe.
Remember the classics... The Christmas Carol, The Little Match Girl, Oliver Twist, etc... And this is when people knew each other better. (ie fewer, smaller communities and no tv)
Now with the decline of Religion and the increase in "Me First", I am not sure folks would be taken care of... The upside... They would be motivated to work at any job... I mean "turkey processing" or "starvation"... Makes turkey processing look pretty good...
Religion Link
By the way, what would we do if they chose to not use their new found wealth on insurance? And they got sick?
Also, would we get rid of the disabled benefits via Social Security that help to support the severely challenged kids and citizens? Also, we would probably get rid of the Special Ed programs for the kids?
I think per your philosophy, the parent's and charities should cover the additional cost of raising the kid, I mean they took the higher risk.
Ta-da! You've got it! There is no personal freedom without personal responsibility for the uses of that freedom. In a world in which government pays, government rules. Where personal responsibility rules and personal charity follows, freedom and compassion thrive.
You are correct. We cannot go cold turkey and take government out of everything it has insinuated itself into in a day or a week. Nor can we retrain a population to become the kind of Americans we used to be-- independent, responsible, charitable almost to a fault-- so quickly, but that is what we need to move towards, not continuing down the path we are on where "Big Brother" is everything, so long as we do exactly as we are told.
J. Ewing
I lost my parents "quickly" to heart attacks, age 60 and 80. That was way too early for dad, but I like what one said about my mother: "Leave it her to miss out on all the getting sick part." She traveled, worked, drove, kept house etc right up to her sudden end.
My grandfather in lived a block from a nursing home, and he told the family more than once to just shoot him before "incarcerating" him there. He, too, got his wish, dying with his boots on helping a neighbor build a shed, at 78.
So for me at 61, yes, I have to increasingly think about such things, especially today with an aunt having heart surgery today. How do I want to go out? Will I even have an option like J.B. Books did in John Wayne's "The Shootist"?
But I do know one thing: I don't want to live to be 150. Those last 50+ years would hardly be worth it. What I don't know is: will I have a choice? It's a whole new area of law and philosophy.
If I was healthy enough, and I set a pretty low bar on that, I would happily live to 150. If you don't, it's only because your bucket list is too short!
J. Ewing
J--Interesting. Really? Wouldn't your resources run out long before you hit that age, though? That's one of my greatest fears about aging. We save like crazy trying to prevent that situation.
Hope I die before I get old, isn't that what Mick & Co say?
If I was healthy enough, couldn't I find work? Wouldn't my memoirs be of great interest, were I the only one at that age? And there is no reason for my resources to run out. Social Security will always be there for me, right? :-^
J. Ewing
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