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Letter: Health care reform foe's rhetoric could backfire

Original post made on Sep 16, 2009

Read the full story here Web Link posted Wednesday, September 16, 2009, 12:00 AM

Comments (36)

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Posted by Hank Lawrence
a resident of Menlo Park: Sharon Heights
on Sep 16, 2009 at 7:29 am

Is health care reform needed? Absolutely. Does the Obama plan answer the mail? The answer is a resounding no. Great Britain and Canada have horrible socialized health care. People from Canada come to the United States and pay the full tab for what is arguably the best health care in the world.

Obama has correctly identified many of the ills with our current health care system. I give him credit for that. Is is just his solutions will result in much higher costs and diluted health care. This is not what the doctor ordered.

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Posted by StopTheLies
a resident of Menlo Park: Allied Arts/Stanford Park
on Sep 20, 2009 at 5:28 pm

Oh, Hank. You continue to propagandize about Canadian health care, which in most ways far surpasses the fairness, efficiency and effectiveness of the US system. And no, there is not an argument about whether the US has the best health care in the world. It DOES NOT. It has an admirable degree of expertise in specialized medicine, no question. But is that specialized care available to many of the people who need it? NO. It's available if you have the money, or, if you're wiling to bankrupt your family.

Our health "care" is a joke in the rest of the industrialized world, where people who need care actually can get it. Stop spreading the lies.

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Posted by Hank Lawrence
a resident of Menlo Park: Sharon Heights
on Sep 21, 2009 at 7:31 am

If you malcontents don't like the United States move to Canada where you can enjoy European style socialism. If the USG has great cost overuns with medicare and is barely keeping its head above water, what do you think will happen to seniors if we let Obama raid the Medicare fund to provide health care for illegal aliens?

Even Robert Byrd the senior democrat in the senate isn't buying this reckless Obama socialist health care system.

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Posted by Keep government out
a resident of Atherton: West of Alameda
on Sep 21, 2009 at 1:08 pm

StopTheLies, Our healthcare system needs improvements that will help the un and underinsured, but the Canadian model, which has recently been described as "imploding" is not the answer. Likewise in the UK many patients wait far too long for treatment, which results in poorer outcomes. Why on earth would we want to turn anything over to the government, let alone our healthcare. Medicare and Medicaid have serious financial problems and it's rediculous to believe that the government would do any better with managing a bigger program. Seniors and those of us with chronic diseases will be in trouble. Why don't we look for solutions that address the real problems that will bring down costs and take care of those who want, but can't get insurance? I want the government OUT of my healthcare decisions and just about everything else, by the way.

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Posted by Government out of my Medicare!
a resident of Woodside: Woodside Glens
on Sep 21, 2009 at 1:34 pm

Who knew there were so many anarchists in this country?

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 21, 2009 at 1:54 pm

Hank -
Canadian & British health care systems have their problems, no doubt. But on the whole they provide demonstrably better care to ALL of their citizens and at much reduced costs, compared to our system. Surely, you cannot believe that the US has the best medical care in the world. The facts prove otherwise:
1) In the US we have longer waiting times for needed care than people in countries with so-called socialized medicine. Only 30 percent of Americans have access to same-day care. In Germany, 55 percent do. In New Zealand, 53 percent do. Americans find it twice as difficult to get care at night and on weekends without going to emergency rooms compared with the Dutch.
2) More than 30 percent of adults in the United States report some cost-related barrier to needed care. If the person has a chronic disease, the percentage increases to 42 percent. This is nearly five times higher than in the United Kingdom.
3) Roughly one-third of American adults had medical expenses exceeding $1,000 in the past year. Only 12 percent of adult Canadians and 4 percent of adult Britons paid this much. So not only do Americans have longer waits for needed care than the citizens of nations with universal coverage; we also ration based on income, illness, and insurance status in such a way that we pay much more for health care than we should.
4) Worse, nearly 47 million Americans lack any health insurance and millions more have inadequate coverage.
5) A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance. In countries with a centralized health care no one goes bankrupt because of health issues ("Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009).
6) According to another published article, about 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs. In countries with a centralized health care no one goes loses their homes because of health issues ("Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures," Health Matrix, 2008).
So tell me again, in what respect does the US have the best health care in the world?

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 21, 2009 at 2:55 pm

Hank -
One other thing. As I understand it, the problem with Medicare is with it's funding, not with the program itself.
From what I've read and heard, most users of Medicare are quite happy with the quality of care and ease of use of the system. Else, why would we hear even conservatives telling Congress to "keep your hands off my Medicare".
Also, a survey published last week that showed that nearly 3/4's of all doctor's supporting some sort of public plan (10% of those favoring single payer), two thirds indicated they were satisfied with Medicare. I got the impression from reading between the lines of the survey that the doctors were willing to put up with the reduced payments of Medicare because the payments & billing were so much straightforward than that required by the myriad of insurance providers.
Funding of medicare is only a problem because the costs keep escalating at 6% a year or so, the same problem that confronts private plans. However private plans just pass along the increases to me and my employer through increased premiums. The government can only pass on increased Medicare costs by increasing taxes, which in the current climate is a no-no. But really, haven't I and my employer been taxed every year by the increased premiums charged by the insurance companies? If we don't get a handle on these increasing premiums, it won't be just Medicare that won't be able to fund the demand.
And finally - just where in ANY of the Congressional bills that have been introduced so far is there anything calling for funding health care for illegal aliens? There is none. In fact, the House Bill explicitly forbids this. This is just the sort of red herring that diverts the discussion and keeps us from focusing on the real issues.

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Posted by Carina
a resident of Woodside: Woodside Hills
on Sep 21, 2009 at 3:38 pm

Health care for illegal aliens is a red herring, but it's also an interesting policy issue.

As a matter of public health, does it make sense to leave one segment of the population out in the cold, un-vacinated and untreated? Is it ethical to allow children to suffer because of their immigration status, when they had no choice in the decision to come here illegally?

No one in congress is going to have the guts to take this on, but as a matter of social justice, it's worth talking about. I wish the president had been lying when he said illegals would not be covered.

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 21, 2009 at 4:26 pm

Carina -
In principal, I fully agree with your comments. But because it is an incendiary issue that could explode the health care debate, I think it should be dealt with after the already difficult problem of reforming our health care system has been resolved. Once we get all Americans covered under a working system, we can explore how non-citizens (visitors, documented aliens, undocumented aliens) are treated when they get sick. Again, we can look to other countries to get ideas of how they cover these people under their nationalized health care systems.

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 21, 2009 at 8:49 pm

Hi Steve and Carina,

Actually, illegal immigrants will be covered, not because of the Congressional Bill but rather because of a Supreme Ct case. That Supreme Ct case says that we must provide social services to illegal immigrants the same way we provide to our legal citizens. So, the Obama supporters can deny it all they want, but they know that in reality, illegal immigrants will be covered by a universal health care bill. Pres and Mrs O have Harvard law degrees - they know this too.

Hi Steve,

You have a few other facts wrong -
1) The US does not have longer wait times than im other countries. In Canada it takes 8 months to get a simple colonoscopy. That could explain why the death rate from colon cancer up in sunny Canada is 10% higher than in the US.... And Germany has private health insurance companies. So, I guess your example proves that private is the way to go.
2) The costs are higher in the US than the UK due to the fact that in the UK many expensive medical treatments are simply not provided. Hence, everything is cheaper.... The UK is known by most cancer experts to be the country that does NOT supply many of the anti-cancer medications since they are deemed to expensive and hence not good. I don't care how much medicine costs - lives are priceless. Is this the model we really want to follow??
3) The 46Million uninsured number that folks keep tossing around is also not quite accurate. That number came from our 2006 census and included 9 million illegal immigrants. Soooo, either we are not covering illegal immigrants and the number is really 37Million or we are. The Obama administration needs to fess up to which # will indeed be used. Also, the 46Million includes children. We already have legislation that covers them. To include them is double counting. That number is at least another 8Million. Then there are those folks who simply do not want to have insurance. I have known people who don't want to spend a dime while they are young and healthy. Let's say 1Million to be conservative. So now we are down to 28Million. A large number, but not quite as dramatic as the Administration would like us to believe. What is my point? That this health care reform will not be as expensive as the Barney Frank's and Nancy Pelosi's would like us to believe. It can be done and it can be done without stealing $622Billion from Medicare to pay for it.
4) Speaking of Medicare - above you say that most users are quite happy with it. Actually, nope - there are already many problems. But it does manage to putter along and most people get taken care of. But Pres Obama has plans to take almost 1/3 of the funding away from Medicare and call it "trimming the waste". $62Billion a year of waste? Are we really supposed to believe that??? No Steve, no one with the facts can believe that. If you take almost 1/3 of the funding away from any government program you will devestate it. No -what the President is proposing is that we replace one group of uninsured with another (ie, the elderly in the future after their funding is cut off). We won't need any death panels. The elderly will simply not get the medical services they need and die off sooner....

In sum, we desperately need health care reform. But we do not need socialist solutions or the robbing of the elderly. Yes, let's look to countries for Germany for their ideas instead....

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 22, 2009 at 12:11 pm

Concerned Voter -

You claim I've got a few facts wrong but you provide no references. I provided several references in my original post. Here are some others:

1) You cite one procedure in Canada that has a long wait time and thereby claim that "The US does not have longer wait times than in other countries." The facts say otherwise in a June 22, 2007 Business Week article that is well summarized by it's headline: Despite spending lots more per capita on health care, the U.S. is often as bad or worse than other industrialized nations in wait times".

2) I would argue that costs in the US are greater than those in the UK not simply because we provide better cancer treatments than they do (which is true). I would suggest that the US has the highest costs in the world (15% of GDP) with fairly poor results because our system is based on the profit motive instead of on a service motive. Insurance companies respond to their shareholders, not their customers and drive up profits by restricting policies to those already healthy and by restricting coverage for those customers who do become ill (driving hundreds of thousands of Americans into backruptcy and/or foreclosure, which never happens in countries with national plans). Doctors and hospitals are compensated based on the number of procedures administered rather than on successful outcomes. These are the fundamental problems with our system that must be changed.

3) OK. Let's take your number of those uninsured as "truth". I say that 28 million uninsured Americans (~10%) is still a scandal and proves the failure of our health care delivery system. When other countries can deliver better health care to all their citizens at 2/3's of the cost we pay, it's clear we've got a failed system that needs fundamental reform.

4) You say I've got my facts wrong when I state that most Medicare users are quite happy with their coverage. Here's my reference:
"Comparisons show the depth of Medicare's popularity. According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according to the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating." Mark Blumental column from 6/9/2009 in

I don't have a problem with socialist solutions as long as they work. I also don't have a problem with private insurer's delivering the service, as long as they work. I'm happy to look to Germany or Switzerland for models. I just don't see that these are the models either party is advocating in the debate going on right now.

And I think that phrases intended to scare people (like "Socialism" and "funding illegals" and "robbing the elderly") keep us from the discussion of these other models that have proved to work everywhere else.

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 22, 2009 at 2:15 pm

Concerned Voter -

Can you provide a reference to the Supreme Court Ruling that you say mandates all illegal immigrants must be provided health coverage?

All I can find in my search is that they must be provided with emergency medical care (ie. ER care), which is a whole lot less expensive than providing the sort of health care coverage being discussed in Congress.

My reference states:

"What is a little known fact is that illegal immigrants are only eligible for very specific public services: emergency medical care, mandated by law, and (for their kids) public elementary/secondary education, which a 1982 Supreme Court ruling said was not conditional on immigration status. A study by the RAND Corporation found that $1.1 billion in public money went to providing non-elderly healthcare for illegal immigrants in 2000. The Congressional Budget Office (CBO) reports that border states incurred $190 million in emergency healthcare costs for illegal immigrants in 2000. But these figures are paltry compared to the $88 billion the government spent for non-elderly healthcare overall. . . it is important to note that most services provided to illegal immigrants are funded by local and state governments, yet any taxes they pay will likely end up in the federal treasury"
Read more at: Web Link

Is this another distortion to throw the health care debate off track??

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Posted by anonymous
a resident of another community
on Sep 22, 2009 at 3:36 pm

Steve -

You made an excellent point when you said "Doctors and hospitals are compensated based on the number of procedures administered rather than on successful outcomes. These are the fundamental problems with our system that must be changed."

I agree completely - this is THE fundamental problem.

My issue with all of the current bills is that NONE of the them address this issue at all.

There are, however, some issues where all sides appear to have agreement. Why not develop legislation that will help patients by (1) preventing discrimination for pre-existing conditions and (2) preventing termination of insurance for reasons other than non-payment of premiums; helping doctors by (3) enacting lawsuit abuse reforms, and helping citizens and businesses by (4) providing partial tax credits for basic insurance premium payments and(5) partially taxing "Cadillac" insurance plans. I don't hear a lot of objections to any of these.

No, this won't fix everything - but it will solve an awful lot of problems (although not the fundamental problem you cited) for a lot of people and it won't cost us another trillion dollars during a time when we're running a $2 trillion annual deficit!

Finally, we may want to fix Medicare and Social Security before biting off the mother of all entitlements which has a high probability of bankrupting our children.

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 22, 2009 at 6:10 pm

Wow Steve, you really need to read more carefully! Some of your responses simply don't make sense. So, I will try again to make my points:

1) My comment re Canada served a multitude of purposes and it is a good example. It was in response to your faulty opinion that Canada "provides demonstrably better care to ALL of their citizens" - a faulty statement for which you had no support. It is well known that Canada's medical system has huge problems financially and in serving it's citizens. Have you ever spoken to anyone who is from Canada and is older than 30? I say older than 30 not as a slur against the young, but because it is generally after 30 that folks start really using their medical community. Canada is a terrible role model for the US. Mediocrity for everyone is not my idea of a solution,

As for my using a Canada exampe to specifically address your comment that there are "longer waits in the US" issue - it is a darn good example regardless of your dislike of it! As for the Business Week article - what does that have to do with Canada? OR defense of socialized medicine? Which was the point I was making - socialized medicine does not work. Most industrialized countries with good care have private care - Germany and Japan. So, let me make myself clearer. The US does not have longer waits compared to socialized medicine countries. The examples often used in several magazine articles are other countries with private health insurance or much, much smaller industrialized countries.

So, my Canada example was good. Canada has a broken system. If copying the Canadians is our idea of fixing the problems in the US, Lord help us.

2) As for your analysis of why costs are higher here, you actually contradict yourself. How in the world can the insurance companies be so stingy and selfish, yet drive up costs??

There are indeed many reasons for the high costs of medical treatment in the US. Some good reasons, some bad. We have cutting edge medical treatments here. Some of those treatments have saved loved ones of mine, so sorry if I don't support the idea of cutting costs as being the most important thing no matter what. The UK DOES keep costs down by simply not providing services. That was my point and it is true, as you also agree.

But some of the high costs of medical treatment in the US do need to be contained and can be. For example, we have allowed hospitals to keep merging into large entities. I know parts of the US where there now is only one major hospital after mergers. We need to have rules that bar such mergers. Monopolies increase the costs of medical care.

Tort reform is also needed. If people were limited to reasonable amounts and attorneys were limited to reasonable %s, then malpractice insurance wouldn't be sky high. Medical malpractice costs are passed down to the patients like you and me. But trial attorneys are huge contributors to the Democratic party, so tort reform is generally very slow in coming, even at the state level.

And let's increase govt spending for drug research. The reason drugs are so expensive is because the patents are privately owned by the drug companies. We can't end their research (thank goodness - the more people researching, the better). But we could increase govt spending on drug research so that the patents that are created could be sold at lower rates.

And speaking of the drug companies, perhaps we could have legislation about the profit levels allowed for the drugs that are sold. AND let's stop letting our US drug companies be bought by foreign companies. Lots of folks are screaming about greedy shareholders. Well, dear boy, many of these "greedy" people live in socialist European countries.... This needs to stop.

Also, I would like to point out that I think people are confusing high costs of medical care with high costs of medical insurance. These are 2 different things and require 2 different sets of solutions. My examples above would help bring down health care costs. Now here are some ideas on how to get the health insurance costs down -

Open up state borders. I don't know if you know this, but right now health insurance companies can not sell across state lines. Why??? If we get rid of these artificial limits, the prices will come down. Economics 101 says competition leads to lowere prices. And let's make sure that these companies then are not allowed to merger into one happy giant monopoly.

Regulate the profit margins for the health insurance companies. And while we are at it, let's definitely stop the pre-existing nonsense that is going on. That is a disgrace and needs to be regulated.

3) And why are you ranting at me about the 28Million??? I am just saying that the Obama administration and Congress is trying to scare us with inflated numbers. If the real numbers were being used, then we could have more reasonable discussions and start working on solutions other than the ones they are proposing. But right now, there is a ton of fear mongering going on. Pelosi would like to think the fear mongering is by the anti-health care folks, but it is by both sides! Fear mongering is accomplishing nothing and may actually end up causing no legislation to be passed. 77% of Americans want health care reform. Over 50% do not want socialized medicine however. So, my point is that Congress and Pres Obama needs to stop trying to scare us and instead start coming up with real solutions to the current health care crisis.

4) And now on to my favorite topic of the day - Medicare. I wasn't clear - I agree to that. But now I will be - Nope, Medicare is not without sin. Most folks are happy enough (as you said), but many are not. But it does putter along. And here is where I have my BIG worry and and if it scares people, good! Pres Obama had repeatedly said that he wants to cut $622BILLION in "waste" from Medicare in order to cover the bulk of the health care reform costs. What the Pres forgets to mention is that $62BILLION a year is almost 1/3 of all Medicare costs. This is robbing the elderly. If you view that as scaring people, great! We need to get people to realize that it is completely unacceptable to steal from Medicare to pay for health care reform. We need to find some other source of the money. I am willing to pay more in taxes, but I am not willing to watch our elderly being screwed after they have honorably paid into the system that they now so deperately need. We found money for the Auto companies, we found money for the banks, we found money for the Stimulous plan, we found money for the cash for clunkers, etc, etc without raiding the defenseless. We need to tell our COngressional representatives that we want health care reform, BUT that we need to find some other source of funds. Many people don't realize that $62BILLION is almost 1/3 of medicare. When I mention that to friends and colleagues they are shocked. Good!

By the way, Anonymous, Medicare is NOT an entitlement. Nor is Socal Security. People pay into those systems ALL their working lives so that they can be covered when they are elderly. Do you view private insurance as an "entitlement" after you have paid your premiums?? Do you view your 401K an "entitlement" when you get your payouts?? The reason that the Medicare and Social Security is going bankrupt is not because they are the "mother of entitlements", but rather because Congress (Republicans and Democrats) have been "borrowing" from the fund for years and not repaying the amounts. I am not elderly and won't be for decades. But I am sincerely offended when our proud elderly are viewed as people getting handouts when all they want is the payouts from the sysytem that they honorably paid into. If you want to make sure that we are not "bankrupting" our children, send an email to Pres Obama and Congress and tell them to stop running up the deficit. I think we all need to do that!

5) As for scaring people in the illegal immigrants - that was in response to your post. I already have accepted the fact that they will be covered. I just don't like the lack of honesty that is going on. If you don't want people to be scared by the illegal immigrant issue, then don't tell people that they won't be covered. I am not the only person who is saying oh yes they will be....

As for the use of the term "socialism", that is the term that is used to descibe Canada and the UK - socialized medicine...which comes from the term socialism. If folks don't want the term "socialism" used , then I would suggest that they stop swooning over the malfunctioning socialized medical systems in other countries.

In sum, I (like 77% of the country) desperately want health care reform. I just don't want the elderly robbed or socialized medicine to be brought to this great country. What we need is major regulations to be implemented (some of which I mentioned above, as also did Anonymous) and some sort of subsidizing for the uninsured and we will see major improvements.

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Posted by anonymous
a resident of another community
on Sep 23, 2009 at 8:49 am

Actually, I do agree that my 401(k) and insurance policy are "entitlements," precisely for the reason you say - I paid for them and I expect delivery of benefits. That's the bargain I struck. No, I don't deny the obligation that government has to pay Medicare and Social Security benefits at all and I plan to collect mine when that time comes.

My point - which you missed completely - is that our government cannot even afford to fund Social Security and Medicare which are EXISTING entitlements, I mean, programs (feel better?). Before we bite off on a new program that will spend trillions of dollars - and that's what I referred to as the "mother of all entitlements" - we should at least make sure we are able to honor our obligations for Medicare and Social Security.

I liken this to someone who can't pay their mortgage and they go out and buy a brand new, expensive car. Only in this case, it isn't a new car, they're buying a new Gulfstream G5 private jet. It's expensive beyond anyone's wildest imagination.

Government should make sure it is able to fund its existing programs before creating new ones, especially one that will have the largest price tag ever considered by any country in history.

By the way, USA Today had a wonderful synopsis of the health care programs in the world - including satisfaction rates. Don't think that everyone's covered in England, France, Canada or Germany or that they all love their programs and are all living 20 years longer than us. It's simply not true.

Here's the link:Web Link

Our system is flawed and needs reform. I've noted those reforms earlier and there's no need to repeat them here.

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 23, 2009 at 10:03 am

Concerned Voter -

Your write:
"It was in response to your faulty opinion that Canada "provides demonstrably better care to ALL of their citizens" - a faulty statement for which you had no support."
I should have included a reference to my claim that Canada provides demonstrably better care than the US, since it is certainly more than my opinion. An ongoing study of six national health care systems by the Commonwealth Fund have consistently shown that the US Health Care system ranks at or near the bottom. This is not based on anecdotal evidence (since all systems have flaws and shortcomings that need fixing) but but an overall analysis of five aspects of health care: 1) quality, 2) access, 3) efficiency, 4) equity, and 5) healthy lives.

The report is: Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care

May 15, 2007 | Volume 59

Here is a summary taken from the report's abstract:
"Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill."

I don't care if Canada has a socialist health care system, if it produces overall successful results for all of it's people it would be an improvement over what we currently have - as the report shows.

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 23, 2009 at 10:11 am

OK Anonymous, it looks like we actually agree on almost, if not, everything. Now we have the same (and clearer :) ) word for Medicare and Social Security - programs. And I COMPLETELY agree with you about England, France, Canada and Germany. I am frankly fed up with the Rep. Pelosi, Rep. Barney Frank and other blind followers of Pres Obama trying to convince us that everything is so wonderful in these other countries and how our system is the absolute worst. Absolute garbage and lies. Yes, we have a lot of problems and we need reform, but let's not use these VERY flawed other systems as role models.

And I completely agree with your suggested ideas for reform (as I mentioned in my last post).

And I completely agree on not creating even more expensive programs before we figure out how to fix our existing programs. It is a disgrace that Pres Obama and many others think that it is ok to not only not fix Medicare, but instead rob it in order to pay for the Gulfstream jet (as you so eloquently describe it!)

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Posted by anonymous
a resident of another community
on Sep 23, 2009 at 10:43 am

Steve -

When you (or your source) compare the US healthcare system to these other countries and conclude that we rank at or near the bottom, you should note:

1. All of the countries you cite, including the UK, are far more economically and ethnically homogenous than the United States. We are, by far, the most diverse of the highly industrialized nations and you must consider that a large portion of our healthcare dollars go treating non-citizens. I'm not taking a stand on illegal immigration, but it's a fact that we pay for a lot of non-citizen healthcare that, for instance, Australians and New Zealanders do not.

2. Not everyone in these countries is happy with their healthcare systems. About 20% of Germans, Australians, Italians and Brits want to change their systems COMPLETELY! (see link I provided earlier for the data) Gee, isn't that the exact same percentage of Americans with insurance (which is the comparable comparitor) who want to change our system? Hmmm...I guess there are unhappy people everywhere. Do you think everyone will be thrilled with the system you're proposing?

Two critical points. Remember that if you're under 21, over 65, or poor, you ALREADY have coverage under a government benefit program. Finally, if you look at the current bill coming out of the Senate, the middle class ($25k to $100k annual income) will actually end up paying MORE in taxes for their new healthcare plan than they do today in insurance premiums and co-pays. That wasn't the point of all this, was it?

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Posted by At Home in Menlo
a resident of Menlo Park: Downtown
on Sep 23, 2009 at 12:47 pm

I love this debate. Concerned Voter, Anonymous, and Steve, you are to be commended by trying to use facts, documenting them, and talking about real situations -- not screaming "socialism" (whatever that is) or other fright words. Thank you!

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 23, 2009 at 3:17 pm

Concerned Voter -

You write: "you must consider that a large portion of our healthcare dollars go for treating non-citizens." This is not true. As I pointed out in a previous post:
"A study by the RAND Corporation found that $1.1 billion in public money went to providing non-elderly healthcare for illegal immigrants in 2000."

The amount spent on care for illegals is really a negligible amount of the total amount going for health care. The reason it keeps coming up in the discussion is that it's one of those "hot button" issues (Illegal Aliens! Socialism!) that get people excited and distracts them from confronting the fact that the US system is demonstrably worse than almost all other health care systems in the developed world. If we can't acknowledge our shortcomings, we really can't get serious about fixing them.

Similarly, the comments about the US being more economically & ethnically diverse as an explanation for our inferior health system also seems a bit of a red herring. Rich or poor, black or white, we all have roughly the same health requirements throughout our lives.

Bottom line: they've figured out how to take care of the rich and poor alike. Why can't we?

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 23, 2009 at 3:30 pm

Concerned Voter -

You also wrote: "Finally, if you look at the current bill coming out of the Senate, the middle class ($25k to $100k annual income) will actually end up paying MORE in taxes for their new healthcare plan than they do today in insurance premiums and co-pays. That wasn't the point of all this, was it?"

No, and if the eventual plan does end up costing more than the current Private Insurance system, somebody should be shot. The latest numbers I've read show the 25% of insurance dollars go to profits and administrative costs (compared to 4% of Medicare dollars going for administration and 0% going for profits). If we can't provide the equivalent care to people when we have a cushion of 25% to play with and everybody enrolled in a plan of some sort, then somebody's not trying very hard.

I actually suspect that the reason for the projected increase in costs is because the Senate Bill doesn't really make any serious changes. The Insurance Companies continue to manage the system and continue to extract their "fair profit" from it. Still, as I read the bill, they will be proscribed from excluding those with pre-existing conditions or denying coverage to customers for flimsy reasons. That's why I support a government plan at a minimum and preferably a single-payer system. It reduces or eliminates the profit motive from the delivery of health care. It also makes for a much more efficient system, which will be huge in controlling costs.

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 23, 2009 at 3:43 pm


I never wrote any of that stuff. You read someoneelse's post, so I don't have the specific info to respond. For example - What I said was that we will indeed be paying for illegal immigrants under the universal health care bill in Congress. I didn't say a thing about how much we currently pay. My comments were merely to highlight the fact that the Democrats are not being completely honest in their sales pitches. Which is a very valid complaint. It's a hot button for some people, so be it. Before people embrace the Congressional plan, they need to know exactly what they are embracing.

By the way, if you may think $1.1 Billion is not a lot of money, I say add to that what is paid for the elderly illegal immigrant population and then tell me what the total is. I bet it is a lot more than $1.1Billion. Everyone knows that the elderly are more costly. Tell me what that total number is and then we will have a more reasonable number to be debating.

Also, that number was in 2000. Big deal - that is not a relevant number. Medical costs have been increasing and so has the number of illegal immigrants. Put that together with the elderly info I am asking for, and BINGO - you will start talking about a much larger number. So like I said above, this should be a hot button.

And Anonymous had another valid point - all these countries that the Obama followers so adore, do have easier and cheaper situations. You may think it's no big deal, but societies that are more homogenious are always easier to take care of. You really think we all have the same problems? You really think things like the gang warfares that we have that leads to so many violent injuries don't effect overall costs? Or the high level of drug abuse we have in this country? I could go on, but I know you will unfortunately still disagree. I am pretty sure Anonymous didn't mean black vs white requirements, or simple poor vs rich.

Anyways, those are my thoughts in response to statements that someone else made.

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Posted by anonymous
a resident of another community
on Sep 23, 2009 at 5:14 pm

Anonymous here.

Steve, you said I implied "the US being more economically & ethnically diverse (is my) explanation for our inferior health system." I said no such thing. What I said it that it was the reason for our higher COSTS.

The debate isn't that our health care isn't as good as other countries - it's that just more expensive. I will stipulate to that!

I don't want to digress into a discussion about people without insurance or illegal immigrants but they get their healthcare at emergency rooms - which is incredibly expensive (and relatively easy and cheap to fix). I'm not sure where your $1.1 billion amount comes from. In California ALONE, the cost is $1.2 billion. Web Link And my number is current and from the State of California. Since California represents about 10% of the country, I assume the national number is about ten times that. But what's $10 or $12 billion here or there...

I don't know the numbers for non-citizens receiving healthcare in New Zealand or Australia, but it's probably not meaningful and certainly less than here. And in Germany, the public system explicity excludes payments for non-citizens.

Finally, the Senate bill has a $3,800 tax for middle class families that don't purchase their own insurance (and copays are ON TOP of that amount). For many families, that's more than they would pay today for a decent private plan.

Silly me, and I thought we were only raising taxes on rich people making over $250,000.

And "At Home in Menlo," I too appreciate the civility and level of discourse on this board. This is an important issue and deserves this kind of discussion. I only wish our elected officials would do this before they declare wars, pass bail-out bills, or revise our health care delivery system.

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 23, 2009 at 6:08 pm

Concerned Voter -

My apologies. We had such an active discussion going that I failed to note that Anonymous had joined the fray.
You were both right to criticize my stale statistics on the costs of providing healthcare to illegals - 2000 is a bit out of date. However I'm not sure that including the elderly adds that much to the bill. As a more up-to-date Jan. 2008 article in USA Today points out:
"Because most illegal immigrants are relatively young and healthy, they generally don't need as much health care treatment as U.S. citizens, studies show. . . they account for less than 2% of national medical spending".
So I guess my point is that if the cost is only 2% of the total, can we limit our discussion of this issue to only 2% of our time? It really is side-tracking us from the bigger questions, such as:
1) should everyone be required to pay into the health care system, whether for insurance or to support a Medicare-like single payer plan?
2) should we try to remove most profit from our health care delivery system, using a system like Switzerland where insurance companies still exist to receive premiums and pay bills but under a strongly centralized and tightly controlled nationalized program?
3) Should we provide a single-payer plan that looks like Medicare for all (as Pres. Johnson originally envisaged), moving the threshold down to 60 years, then 55, and so on until everyone is covered?
4) Is there a way to get costs under control without resorting to a vastly more centralized system that limits profits, administrative overhead, price increases?

I'm out of town tomorrow but I hope this discussion is still going when I get back on Friday.

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Posted by Anonymous
a resident of another community
on Sep 23, 2009 at 11:11 pm

Thoughtful response, Steve, thanks.

My last (hopefully) comment on coverage for non-citizens - The bulk of a person's healthcare expenses often occurs in the first and last few months (or weeks) of life. It's nice to "miss out" on the end of life issues, but we certainly incur the beginning of life costs. You are free to draw your own conclusions.

I appreciate your four points but none of them (and none of the proposals coming from our Congress) address the actual cost of healthcare. Please note that I am intentionally EXCLUDING delivery costs from insurance companies versus government - I agree there's about 20% of savings there. Since private insurance represents about half of all expenditures, that change alone would save up to 10% of the total bill... not an insignificant amount.

The healthcare market is flawed in that the patient receives the benefit, the doctor/hospital receives the payment, and the insurance company pays. No other market segregates the buyer, seller and payor like this and it simply doesn't work so well.

Even in healthcare, when the patient has "skin in the game," costs go down. Don't believe me? The price of cosmetic surgery and cosmetic dentistry have gone down dramatically during a time when other healthcare costs have skyrocketed. Why? Because you have to pay for them yourself and providers have to be competitive to sell their services.

My first suggestion is counterintuitive - the patient needs to have more skin in the game, not less. I would suggest that insurance be catastrophic in nature and only pay for expenses only over a specific amount, say, $1,000 per person. It should be relatively inexpensive because insurers would only pay for hospitalizations and serious illnesses. Yes, I know that the poor can't afford that and for those not covered by another program (and most are) it could be addressed with tax credits or an extension of the Medicare system. But the vast majority of Americans can afford this and having to pay the first $1,000 themselves will make each person a much better gatekeeper for their own treatments and question these routine expenses.

The second suggestion is that we need to have that conversation about "end of life" expenses. Because so much money is spend at the end of life, we need to establish protocols that say, no, we're not going to perform certain expensive treatments on people over certain ages (unless they pay for it themselves) or provide expensive, heroic treatments to patients that have no chance for survival.

Awkward, yes, but this is the only way we're going to REDUCE costs. In the end, whether Aetna or Uncle Sam pays for it, we need to give an incentive to patients and providers to reduce costs. Right now, they have none.

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 25, 2009 at 10:01 am

Anonymous -

While have qualms about your first point about giving people more "skin in the game" I agree entirely with your second point about reigning in the treatments made available to people at the end of their lives. Turns out there's an opinion piece in the NYTimes that lays out this problem nicely and suggests that states like Oregon have blazed new trails in dealing with this problem. Check out the article at:

Here's a few of the cogent paragraphs that summarize the dilemma.

"With his mother's death in 2005, Kitzhaber lived the absurdities of the present system. Medicare would pay hundreds of thousands of dollars for endless hospital procedures and tests but would not pay $18 an hour for a non-hospice care giver to come into Annabel's home and help her through her final days."

"The fundamental problem is that one percent of the population accounts for 35 percent of health care spending. About $67 billion — nearly a third of the money spent by Medicare — goes to patients in the last two years of life. The need to spend less money at the end of life "is the elephant in the room," Evan Thomas wrote in "The Case for Killing Granny," the cover story in last week's Newsweek. "Everyone sees it but no one wants to talk about it."

"John Kitzhaber, M.D., politician, and son who watched both parents die in a dignified way, cannot stop talking about it. His parents' generation won the war, built the interstate highway system, cured polio, eradicated smallpox and created the two greatest social programs of the 20th century — Social Security and Medicare."

"Now the baton has been passed to the Baby Boomers. But the hour is late, Kitzhaber says, with no answer to a pressing generational question: "What is our legacy?""

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 25, 2009 at 10:24 am

Anonymous -

The problem with shifting the costs back onto the patients to give them more incentive to control their medical usage is that it will discourage people from getting treatment early, when serious problems can often be prevented. Instead, they'll wait until they have no choice but to see a doctor, at which point heroic (and expensive) procedures will be likely be needed, treatments will tend to be more prolonged and may involve hospital stays, and the patient is more likely to suffer long-term negative consequences.
I think asking patients to cover the first $1,000 of costs per person (in any one year?) is way too much and that people will skips seeing the doctor, rather than fork over the cost of an office visit or the full cost of a prescription.
Seems to me that co-payments already give people an incentive to limit usage to real medical needs. Perhaps increasing copays is a way to discourage frivolous usage.
Actually, I'd like to see statistics on how much medical usage is considered frivolous. Are we sure that this a real problem that contributes appreciably to the total health bill?

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 25, 2009 at 8:47 pm

Hi Anonymous,

I have to say that I completely disagree with your end of life comments. I have seen 3 people in my life live for many years after "heroic" procedures were done when their odds were pretty zilch. One is now in his 90s and doing great, one is in her 80s and doing great. The third person lived on for many. many years. Doctors are often wrong. And to see human life decided on based on statistics and age makes my blood run cold. We find the money for all sorts of garbage projects in this country (like cash for clunkers), sure we can find the money to respect life.

But I do agree with your "skin in the game" thoughts. Although, perhaps less than $1000 per year. Maybe $500 or $750? Many health insurance plans already have such deductibles. Or make the co-pays $20? They seem to have stayed at $10 for eons.

And Steve,

I read that biased article from Newsweek on "Killing Granny". The author was not objective at all. Her mother was part of a group of people that do want to die when they get that sick and old. While I do respect their wishes, I don't see why that has anything to do with those who have the will and desire to live even when they are old and sick. To be honest, I found her story very non-typical. My parents and friends' parents have had the complete opposite experience with the medical community. Generally doctors recommend giving up when the "suffering" appears to much to them - not more medical care. I have never personally seen or heard from any of my friends or colleagues that any of our loved ones ever had their lives and medical care prolonged unnecessarily. I have shared stories with countless others and we don't know what "white elephant" in the room that the Obama supporters are talking about. In fact, I remember years ago there was a Newseek editorial by a woman who even complained that the doctors kept trying to convince her to let her mother die by slowing down the medical procedures despite the fact that her mom wanted to live. But the doctors souldn't believe that someone so ill actually wanted to live.... The woman's mother lived on for numerous years. The medical community generally believes that these ill elderly are unhappy and want to die and it is family members who want to keep them alive too long. Doctors kept asking my father if he wanted antidepressants since he surely must be depressed being so sick. Hogwash. He turned them down every single time. Of course he wasn't happy about being ill, but he was so dearly happy being with his family who loved him. And I watched him get sicker and sicker and ultimately we lost him. And EVERY step of the way, he had more dignity than anyone I have ever seen. And EVERY step of the way, he greatly appreciated his life with his beloved family. No one took his dignity away. And his mother before him behaved in the same gracious and loving way when she was ill and she also fought to live. Before we embrace Obama's panels with their statistics, I say that we need to speak up and say that our generation's legacy is that we will indeed stand up and look at each end of life case individually and screw the statistics. Decisions will be made on a case by case situations, not a bunch of statistics. These are difficult decisions, and therefore need to be made with wisdom and heart, not across the board statistics. Making life and death decisions are not "hard" like Pres Obama says. Using statistics is how to make the decision making very easy. Hey Granny, let's just look at this chart to see whether to treat you... Let our legacy not be "Granny is too costly to save...."

But I do agree with you on the $18 hospice care. Did you know that Medicare won't pay for a great deal of in-home care and instead it is Medicare that forces these unfortunate sick elderly into the hospitals in order to get treatment? If we got rid of the idiots who came up with that idea, we would save a ton of money on hospital care and their salaries!

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 25, 2009 at 10:06 pm

Correction - I noticed that I miswrote above when I said "making end of life decisions are not hard like Pres Obama say". Actually, those decisions are extremely heart breaking. I have already been part of such a process and it haunts you for the rest of your life. What I meant was that Pres Obama says the decision to give Granny a pain killer is hard, but he says that we need to stick to statistics. It's not "hard" if we stick to statistics.... It is only "hard" when we try to use the best wisdom and love with each individual case. Pres Obama's govt panels and their cold statistics makes the process very clean, sanitary, easy.....and cheap.... Get these panels out of the Legislation now. I don't need a govt pinhead telling me when to pull a plug.

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Posted by anonymous
a resident of another community
on Sep 27, 2009 at 10:25 am

Concerned voter -

Unfortunately, the end of life decisions are where the money is. We're not going to make a dent by attacking $150 doctor visits or $50 monthly prescriptions. An 85 year old who suffers a stroke, gets heroic interventions and spends a week in the ICU before dying will have a $300,000 bill. That's where the money is - but no one wants to have that difficult discussion.

Yes, I may want everything done to save a member of my family with a hopeless prognosis... but I should be willing to pay for it, not ask you to do it. We don't make decisions about crime and punishment based upon personal feelings (ie, if someone murdered a member of my family, I may favor capital punishment), this is a societal issue and we have to be more dispassionate.

We have all read heart-warming stories about the one patient that beat the odds. That happens. But just look at the obituary sections of newspapers to read about all of those people that didn't beat those odds. They are the other 999,999.

It is irresponsible to make policy decisions about risk-sharing insurance - to protect that one in a million event... unless you want to go broke.

Yesterday on PBS, I heard Iowa Senator Tom Harkin say that he wants health care legislation to provide for zero deductibles and zero co-payments. Wonderful. What incentive does a patient or provider have to reduce tests or treatments?

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 27, 2009 at 9:04 pm

Frankly Anonymous, I am horrified that you think it is ok to refuse medical care to someone simply because they are elderly and your made up 1 in a million odds. Or because there are a lot of elderly in the obituraries. Shall we apply your logic to those who are deformed? or mentally retarded?

And I am not asking you to pay for it. I am asking the Medicare program to pay for it, which is funded by those receiving the services. Unfortunately Congress has been "borrowing " from that fund for years and not paying back. Now there is a shortage of funds and the answers suggested by the Obama administration and clearly you is to simply stop treating the old coots since they are expensive. People like you need to realize that it is a disgrace to tell someone who paid into a system all their working lives that they can't now get the medical services because the "younger" gerneration does not view it as cost efficient. (I am part of the younger generation, so don't think that I am just trying to protect my turf.) I am not referring to the extra week of care that you are basing your entire incorrect argument on. Those are rare stories that are being circulated by the Democratic party in order to scare people like you into supporting the 33% cuts to Medicare spending. I am talking about refusing the pacemaker to an 80 year old simply because Obama's cold hearted panels (yes, shall I use the term? death panels...) have come up with a chart that says most 80 year olds wouldn't survive long. I want doctors and families making such decisions. Not Obama's death panels and certainly not people like you who view them as too expensive and assume all services for the very old must be 1 in a million. These stories are actually not 1 in a miillion as you say. They are common events - people with perhaps 20% chance of survival or even 10% according to a chart, but whose odds are actually higher when you view them as individuals who have a will to live and will beat the charts which reflect a general population. Go talk to some doctors - they will set you straight with real stories and facts - not the made up scary expensive stories of the Obama administration. Clearly you are buying all the garbage that the Obama admimistration is pushing. The medical community does not even do these ridiculous 1 in a million services. Nor do they do tonsilectomies or amputations only to make money as Obama acused doctors of doing. So, when a doctor says someone needs medical care, i want the doctor making the decision.

By the way, I really don't know how you think the obituaries prove anything. Lots of young people are in there too. And frankly, a LOT of people who have died from cancer. Shall we stop the cancer treatments since the obituaries contain a LOT of cancer deaths???

Another question - what % is ok for you? clearly not 1 in a million, but what? is 10% good enough? 5%? It's a slippy slope to start 2nd guessing the doctors when this panel (and you) don't have medical degrees and are deciding only on cost and general population percentages. Soylent Green, here we come.

Another interesting fact to consider - people are living longer. Japan and the US has the fastest growing 100+ population. That is, until we have a bunch of govt nitwits deciding that our old folks cost too much.

I find it interesting that folks who support the Medicare cuts are usually the same ones screaming when private insurance companies don't want to pay something for them. But when some old coot needs something, you don't mind saying too bad, according to the obituaties and a nifty new govt panel with general population statistics you are probably going to die sometime soon.

As for the zero deductibles, that is never going to happen for the middle and upper classes. That is just a smoke screen being tossed out. When the final legislation is done, you can rest assured that the rest of us will still have our deductibles. But that is one thing I do agree with you on - everyone should have co pays in order to make sure that folks don't go for medical service for frivolous services.

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Posted by anonymous
a resident of another community
on Sep 27, 2009 at 9:48 pm

Horrified? Really?

See, I told you this was the conversation that no one wanted to have. Unfortunately, it's the only one conversation that addresses how much money we are spending on health care.

You should re-read your post. Almost everything you noted (and everything the Democrats have proposed) will cost us MORE money, not less. And I do mean "us" because the taxpayers underwrite and subsidize Medicare, Medicaid and all of the proposed new programs. None of them are supported solely by participants - and it's not even close. These programs represent almost all of government's non-discretionary, non-military expenditures. Almost all.

You should know that I'm against all of the health care reforms that are currently on Congress's plate (except the five - get rid of pre-existing condition qualifiers, tort reform, etc. - I've stated earlier).

I'm not going to debate you on whether or not we spend most of our health care dollars at the end of life. That evidence is overwhelming and the jury's long decided that issue. If you won't admit that fact, there's no reason to read on.

I do wonder if you like the UK health system. Based on your comments, I suspect you do. (By the way - I'm no fan of the UK system. Like about three-fourths of us, I'm quite happy with our current system, thank you.) The UK system is governed by a group called NICE - the National Institute for health and Clinical Excellence.

It's not about setting a percentage of survival to decide if you'll get treatment or not. It's about setting a price on a "quality adjusted year of life." To make this simple, NICE says it's approximately 30,000 British pounds for a quality adjusted year of life. So, if a 60,000 pound pacemaker procedure will add more than two quality life years to your life, you'll get it and they'll pay for it. If not, you won't get it.

Google it if you don't believe me or go to their web site: Web Link

For a quick summary of quality life years, you check this out: Web Link

So instead of asking me the question, I would ask you: "how much is an extra week, or month of life worth?" NOT TO YOU - because, like me, that would be "anything it costs, pal." But to society. Should taxpayers pay $100,000 to give someone an extra week of life? How about a month? And these are "quality" years, not just hooked up to life support.

We should discuss that number - that's a conversation worth having and this will change the cost of health care dramatically. Unfortunately, no one wants to.

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 27, 2009 at 11:02 pm

Unfortunately, your ignorance about the elderly is showing... First, you jump to the ridiculous conclusion that I like the UK system which is 100% wrong. I have family in the UK, so I know first hand what a disaster that program is. Just because I happen to more knowledgeable about the elderly and their medical care does not make me a UK socialist.

Second - I never disagreed with you that the bulk of the money is spent on the elderly in the last 2 years. What I said was there is absolutely no overwhelming evidence that a huge amount of money is spent on the elderly when the odds are 1 in a million or when they are on life support. This simply is not true. We are not keeping all these half-dead people alive. Yes, the statistics show that a large amount of money is spent on a person's last 2 years of life. But those years are generally precious and are considered "quality" years by the elderly in question. It is usually only the last few weeks or even week that is truly the end of life for most where they are in the hospital. And most people are actually dying at home these days, since contrary to what Obama says, doctors actually try to help the elderly die at home with their families. Or are you suggesting that we stop caring for all of those who are getting weaker and closer to the end? are you suggesting that we stop, for example, giving chemo to an elderly person who might die in a year or two to save money? but who could live another 10 years if we give him a fighting chance and he has the will to try to survive? Those are the costs that are creating the bulk of the Medicare expenses. Not those ridiculous stories about Granny on life support. You and many others seem to be mixing up the cost statistics for the last few years with the costs of that extra week. I am trying to explain to you that the Obamites are deliberately trying to make Americans think that the bulk of costs are those last weeks. That is the only way to get the public to support their Soylent Green ideas. I am trying to explain to you while the bulk of expenses are for the last couple of years, that is because folks often need more services because they are getting frailer - but they are not at deaths door, they are not in the hospitals hooked up to machines. The medical costs for the average elderly person for the last few years is for things like more requent checkups since slight changes are more crucial, high blood pressure or cataract surgery or heart medication or cancer treatements or some other issue where they are still mentally alive and want to live. And Yes, the last 2 years are "quality" years for those elderly. Your "difficult discussion" therefore is to play God and decide that those years are not "quality" and therefore society shouldn't pay for them. Obama and his henchment want to convince us that the bulk of expenses is due to the elderly spending their last 2 years hooked up to life support. Get real. Go talk to the doctors. There are not these masses of elderly attached to expensive life support. That is nonsense.

By the way, I personally do not mind paying to help support our elderly have their last 2 years. And I don't mind paying for them to have what their doctors recommend. I have no desire to start playing God and questioning what a person's medical expert has recommended. And frankly it is a disgrace that we are even having this discussion as if these medical payments are a handout to the elderly. The elderly paid into the system and if Congress hadn't been "borrowing" (pilfering) the funds these last couple of decades, there would be plenty of money. But Congress played fast and loose, so now you think it is ok to say too bad to Granny??

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Posted by anonymous
a resident of another community
on Sep 28, 2009 at 9:47 am

We probably agree on more than you may suspect and I apologize that I suspected you MAY like the UK system (I said that "I wondered" if you did, I didn't say you liked it...).

About 30% of all health care dollars - that's ALL health care dollars - not just Medicare dollars - are spent in the last 30 days of life: Web Link Stop for a moment and think about it - that's a huge amount of spending - nearly a third of all dollars - and it only buys the poor patient 30 days! And I'm very familiar with our health care system - I've spent more than 30 years in it. The final days for most patients are hardly enjoyable.

For a final time, my point is not that each second, hour or day of life isn't precious, especially to the dying patient. My point is that it comes with a cost to society. If your position is that you are willng to pay ANYTHING for ANY additional moment of life, that's great... but it's a certain and very fast road to financial ruin. You're welcome to do this for yourself and your family, just don't ask others to foot the bill.

My problem is that I thought the idea of reform was to reign in health care costs, not increase them. Yet every proposal I see will add more expense, not less. I think we need to address the elephant in the room and it's not the $150 office visit that happens once or twice a year. It's the 30% of lifetime expenditures - hundreds of thousands of dollars - that happens in the last month of life. That's often a near senseless expense - unless, as I've noted, you're that person - I understand that.

I am a great believer in market forces and in our health care system (except for cosmetic and elective procedures), there are no market forces. Patients get the benefit, doctors and hospitals get paid, insurance companies pay the bill. Try to think of another market that works that way! By the way, during a time when other health care costs have more than doubled, the cosmetic and elective procedure market (which usually require hospitals, operating rooms, nurses, anesthesiologists and devices), costs have fallen by about a third because patients pay their own way and doctors have to be competitive. That's market force.

Now you just said that you "personally do not mind paying to help support our elderly..." That's nice, but that's not what you said in an earlier post when you stated, "...And I am not asking you to pay for it." Which is it? If you want to pay for other's care, that's fine and you can do it today without any changes to our healthcare system at all.

These are very difficult decisions but our Congress does this every day when they decide to build a bridge in Alaska versus funding a homeless shelter in Topeka.

I think you'll admit that we shouldn't pay a million dollars to give a dying person one extra day of life. That's a start. Let's try to decide on the amount of money that a day or week or month is worth so we can begin making more rational spending decisions.

I appreciate the opportunity to have this civilized discussion with you.

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Posted by Concerned Voter
a resident of Menlo Park: Stanford Hills
on Sep 28, 2009 at 11:16 pm

Hi Anonymous, I think you are right - we do agree on most topics.

And we agree that the last month of life is generally a very difficult experience for the elderly and their family. I would have to say that my father's last few days were the most horrible time I have ever seen anyone go through. He remained as gracious and as brave as he was every other day of his life, but I will always remember his suffering to the day I die. But those last few days certainly did not break the Medicare bank. He was not hooked up to all sorts of ridiculous machines since he had told us before hand that he did not want to end his life that way.

And I agree with you on what the goals of the health care reform was supposed to bring costs down. Instead, as you say, everytime I read what Congress wants or what Pres Obama wants, I see costs increasing tremendously! As for why the health care costs have increased in the past, I think there are many reasons and not simply due to the supplying of too many services. I think, as I mentioned above, that all the medical malpractice insurance needed in today's world of outrageous lawsuits has caused costs to incease. I also think that the lack of competition between insurance companies due to the restrictions of selling insurance across state lines has caused prices to go up. Also, the lack of caps on profits of the drug companies - many who are foreign owned has jacked up prices. Speaking of the lack of competition, we have allowed hospitals to keep merging until they are now also often huge conglomerates. Etc, etc. We have a whole world of fixing to do and I am worried that the current Congress is too much in love with the nationalized medical systems in other countries and think that nationalizing everything will solve all problems. Hopefully they will stop that and start focusing on making some of the needed changes. Also, hopefully, they will stop trying to rush this legislation through and start a more careful analysis of the complex topic. Personally, I would rather see the chamges be made in phases so as to ensure that we are going down the righ path.

I also very much appreciate having this civilized discussion with you. And I learned several things from reading your posts. Thank you.

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Posted by Steve
a resident of Menlo Park: Felton Gables
on Sep 29, 2009 at 1:49 pm

Concerned Voter -

I've been away for awhile so it's been interesting to getting up to speed by reading your discussion with Anonymous. I'm glad to see that these on-line arguments can actually converge on common ground rather than diverge into warring camps.

I do have a bone to pick with you though based on your response to an article in Newsweek that I'd referred to. You wrote:

"I read that biased article from Newsweek on "Killing Granny".
The author was not objective at all. Her mother was part of a
group of people that do want to die when they get that sick and
old. While I do respect their wishes, I don't see why that has
anything to do with those who have the will and desire to live
even when they are old and sick."

First, I didn't notice any bias in the article - can you point out where you saw it? Evan Thomas (a guy by the way) was just explaining the experience he observed in the hospital when his mother was dying of emphysema. She knew she was dying and requested that the doctors stop "the various tests and procedures to keep her alive". From her viewpoint, they were extending her suffering for no good reason - no one is cured of late stage emphysema (I know - my Dad died of it 4 years ago). From the doctor's point of view, they probably felt the need to do something to show her family they were trying. I wouldn't go so far as to accuse them of being greedy but, in fact, the payments they and their hospital could claim from Medicare depended on them doing more "tests and procedures", useless though they might be.
And that, I believe, was Evan's point in writing the article with the alarming title "The Case for Killing Granny". Evan was never making the case that we should be killing Granny, only that death is a part of life that we need to learn to accept. His mother understood that and asserted her will on a reluctant medical staff. The larger lesson from his experience: if we're ever going to get a handle on controlling end of life costs (fully 1/3 of all Medicare payments!) we need stop bankrupting Medicare (and the larger society) by extending life at all costs. Or in the case of Evans mother, extending her suffering at all costs.
You say that this story is "non-typical". But it is very typical for terminal illnesses like emphysema, lung cancer, pancreatic cancer, and others that claim millions of lives each year. Making the dying person comfortable during their last days, rather than assaulting them with expensive tests & procedures, is not only more humane, it's also a more appropriate use of scarce resources.
This is the part of health care reform that's the most difficult and the most needed.

Any agreement here?

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