Moon of Alabama Brecht quote
July 31, 2004
Health Care Moral Question

Health GDP

In 1993, at the time of President Clinton’s doomed health care reform proposal, the nation’s medical system made up 13.7% of its GDP and employed 11 million people. Nine years later, in 2002, health care spending exceeded $1.6 trillion, or $5,440 for each American, amounting to 14.9% of the nation’s GDP–compared to 9.7% in Germany and 9.5% in France (in 2001, according to the Organization for Economic Cooperation and Development). Government projections in 2003 estimate that health spending will consume 17.7% of the GDP by 2012.

However, American life expectancy at birth ranks behind fifteen nations, all of which spend proportionately far less on health care. Infants die at a higher rate in America each year than in 21 other countries, …
Kearl´s Guide to Health Statistics

There are many reasons why health care is more ineffective and costs are higher in the US than elsewhere. Most of them have to do with market manipulations in favor of the health/insurance industries. A consequent policy would most probably allow for a general health insurance at lower total costs and with better total result. But even if applied, this would not answer the real questions.

  • How much to spend for (expensive) emergency care vs. (cheap) longer term care?
  • How much to spend to prolong a fulfilled life for three or maybe six month?
  • Should a life be prolonged or shortened even against the will of a person? Who should take the decison?

In the western montheistic theological society people dodge these question, willfully ignoring that they do get answered in stealthy ways everyday in hospitals, nursing homes and home care without discussions and without majority sanctioned criterias. Will we ever answer them?

Comments

This concept that “expensive end-of-life care” is a critical question really grabs the imagination. Frankly, it’s a lot of b-s.
For 25 years I’ve been working in direct patient care, 24 of those as an RN. In that time I’ve had one patient who died after expensive end-of-life care.
For the past three years I’ve spent three half-days a week at a local nursing home. I would guess that about five patients a month die there, none of them with expensive end-of-life care.
OTOH, I’ll never forget one of my first patients at one hospital. She had had 11 abdominal surgeries at another hospital (for no clear reason) and was admitted to our floor as a pain patient- our doctors just couldn’t find any reason to do another operation.
Half of America’s diabetics would not be diabetic if they reduced their weight to HWP and got an hour of exercise a day.
There’s a long list of culprits for expensive health care, and the simple fact is that if we reduced our costs to the same ratios enjoyed by the world leaders, we would be doing fine.
To look at the incredible mess of oligarchies, monopolies, malpractice and incompetence that we call health care, and conclude that the tiny minority who cling to life for more than a few hours is at fault, is simply mind-boggling.
And that’s putting it nicely.

Posted by: serial catowner | Jul 31 2004 21:12 utc | 1

thanks, catowner – don’t blame the patients! as a physician’s wife and friend of at least one unemployed nurse, I must agree the main culprits in this country are the insurance industries, though there are many players – attorneys also drive up the cost, though not as per the tired old mantra about trial lawyers – attorneys advise hospitals and doctors on how to maximize profits and cut losses even to the detriment of patients; technology companies push sales of machinery in every tiny clinic and underserved-area hospital, etc., etc. Too much of a honey pot from unethical types all around. Doctors too, since now they often refuse to care for the uninsured.

Posted by: francoise | Jul 31 2004 22:03 utc | 2

Let’s face it: Every health care system must be improved, because after all this is the age of constant product improvement. Everything is simply getting better all the time. So send in the consultants, the advisors, the controllers, the lawyers, the lobbyists, the human resources developers, the salesmen, the commissioners, and the grinning politicians for the pointless photo-ops.
Look at that poor sucker over there – a patient. What’s she doing here? Show her the door, and tell her to take care of herself. How do you thnk we are going to improve the system with this kind of people around? Know they no shame?
Right, I’m off to bed. Sleep. Wholesome. Good night.

Posted by: teuton | Jul 31 2004 22:33 utc | 3

You know, it’s not just a question of expensive medical care — it’s a question too of having reasonable preventive or interventionist care.
Case in point: My daughter, who has a heart defect and pacemaker, fainted at school in the first week of May. She ended up in ICU. During this period, we were informed by her primary physician that he no longer wanted to be her primary physician (the gatekeeper to the specialists) — no reason was given, but I know it’s because gatekeeper physicians get bonuses from the HMO for NOT referring patients on.
Okay. No person to give referrals — her cardiologist kept her on anyway, ordering a EP cath study done. But he’s not authorized by the bureaucracy to start this paperwork. So for five weeks we’re in limbo, fighting the HMO, trying to get a gatekeeper physician in place, etc. Kid faints again, is hospitalized again. Twice. Each time, three days in ICU on every heart monitor imaginable (all indicating the kid has tachychardia, etc.).
Finally, the cardiologist says screw it, threatens the HMO with never working with them again, gets her into UCLA where — voila! and duh! — she needs an ICD implant.
Like we figured that out in May, you dimwits.
So my question is: How much money did the HMO really save by rewarding the gatekeeper physician for NOT referring in the first place? Aside from the moral/ethical issue of letting a teenager walk around on the edge of dropping dead, wasn’t it a stupid financial decision? Referring for the inevitable EP study and ICD implant would have saved seven days in ICU.
This just makes no sense to me.
And sorry to hijack this discussion with a personal story, but I’m a mom and — damn it! — I’m pissed!

Posted by: SusanG | Aug 1 2004 0:28 utc | 4

Alright you Europeans and SusanG, what would you offer a candidate for state rep in the US as a talking point for state sponsored health care as opposed to federal health care programs?
Personally, I and I think SusanG, believe health care begins right here in my own kitchen. But how do I present that to prospective voters?
And also what could be offered to the elderly who are getting f**ked at every turn by most every corporate health care provider?

Posted by: Juannie | Aug 1 2004 1:31 utc | 5

Good question, Juannie.
I don’t know how feasible it would be, but if you did research and found out it could be cost-effective, how about the state footing the bill for annual check-ups for residents and immunizations? And then if a problem is found, specialist or long-term care would kick over to health insurance or the feds?
After all, detecting a problem early — like diabetes or coronary heart disease — would save money in the long run for someone, wouldn’t it? Teaching people early on to manage their diabetes, for example, would surely cost less (and be more humane) than having to foot the bill for hospitalized episodes of diabetic coma.
And immunization makes sense because it’s cheap and keeps everyone’s child (and adults as well) safe by ensuring that measles epidemics and such don’t occur.

Posted by: SusanG | Aug 1 2004 1:52 utc | 6

Juannie: “health care begins right here in my own kitchen”. Agreed. But what if the people who sell the oversized and unhealthy food (and pay for the advertising wizards that incite people to actually consume the stuff) follow the same logic as the people who get their money out of treating the very diseases that have been caused by the logic of consumerism in the first place?
I would propose two main points:
a) Money for ‘health education’. Take it to the schools and kindergardens, and make sure the parents are well informed as well.
b) The incentive for the people in the industry should be the well-being of the patients, not the sales figures of ever more equipment and substances.
How to effect this? Sorry, but I am too underinformed again. We do have a massive discussion going on about public health care here in Germany, and as usual, it seems that the problems are nobody’s fault. I worked with elderly and disabled people for a while (Germany offers you to do civil service instead of going to the military), and the people I met there were definitely not the ones who received high-tech medicine. I guess you’d have to devote a large part of your time to the topic if you really want to get through all the misinformation and spin. More time than I have at the moment anyway. I just saw that some of those who really need better care are not getting it, and it shocked me.

Posted by: teuton | Aug 1 2004 8:16 utc | 7

Our economy is partially based on promoting bad health. Advertising tells us: “eat lots of unhealthy crap” “eat all the time” “sit around and watch tv” “drive everywhere instead of walking or taking the bus” etc.
I recall reading something about health insurance plans giving people a better rate for staying healthy…or maybe what I read was just a discussion of the need for restructuring the system like that. It makes sense. Health plans should require annual physical exams, and if individual results show one is staying healthy (i.e., healthy weight, blood pressure, and other indicators,) they should qualify for a reduced rate. Of course, that means less money for the profit-making companies, at least up front.

Posted by: maxcrat | Aug 1 2004 8:38 utc | 8

@teuton
I just saw that some of those who really need better care are not getting it, and it shocked me.
And some who probably should do without do get too much care.
My father was 76, nearly 40 years diabetic plus heart problems. The doctors put him on dialysis and through two operations against the will of his family and his will (though he was unconscience at that time he had claimed this before). It took four month of intensice care before he finally died and did cost the insurance some € 200,000. That money was wasted, but the doctor had his station filled.
There is something morally wrong with a system where emergency/intensive care is done without cost limits and low tech home care is underfunded.

Posted by: b | Aug 1 2004 8:41 utc | 9

Thanks for the feedback SusanG & teuton.
State sponsored yearly checkups and early education are probably doable. I’ll run this by a democratic incumbent who has been working on legislation and get his opinion.
Incentives to the industries? I have heard that there are systems of health care where patients pay their providers while well but stop paying when ill. That would surely be incentive for the providers to encourage general health in the population but in our culture I doubt it would work. An alternative health care provider once offered to take me up on that. I didn’t follow through.
Except for a hernia operation a few years ago, my health care has been pretty much in my own hands. I’ve had good results from eating all raw and live juice fasting when I have health concerns. I have zero health insurance but I get almost free checkups from the VA. The hernia operation only cost me about $100 at the VA hospital but it would have been about $4000 if the local hospital had done it. I feel I’m ok about moving on when the time comes but need to fill out a Living Will. I don’t want to be in b’s father’s situation and end up having my family stuck with the bills.
Hemlock and poppy tea would be more to my liking at that point.

Posted by: Juannie | Aug 1 2004 12:28 utc | 10

Basically, for the U.S., a universal coverage plan is the only way to make real changes.
Without universal coverage you get endless complaining, state legislatures cutting and recutting the nature of the coverage, and no universal approach to cost containment.
With universal coverage you get the clear ability to reckon your costs on a national level. To the extent that pollution, eating habits, exercise, or national transportation choices affect costs, this is a way to get a handle on those costs.
Back in the 70s politicians realized that overbuilding of hospital beds was a major driver of higher costs. I believe most areas today have local agencies tasked to assess the need for new hosptial beds or expensive equipment before issuing a ‘certificate of need’ that authorizes their purchase.
Unfortunately, a large regional hospital can almost laugh at local controls, if experience in Seattle is any guide.
State legislatures can mainly act in implementing federal programs. There’s a lot of room to act here because (amazingly enough) Republicans block implementation of stuff that could be done, and largely paid for, by federal programs.
However, especially with a highly mobile population, the key lies in universal coverage.

Posted by: serial catowner | Aug 1 2004 12:55 utc | 11

Hi everyone,
just got back! Lot’s of interessting threads have been going on while I was gone. I hope to catch up with them.
I am very interessted in this one and have a few ideas to share, hopefully I will be able to write during the day. I think health is a very complex topic and just changing to universal health care is not going to change the problem (I am not against it), because it will only palliate some of the symptoms. But more later.
Right now I just want to post the article I found in this mornings Independent.
The medical timebomb: ‘too many women doctors’

Nice that they are finding some new/old scapegoats for the problem!!!

Posted by: Fran | Aug 2 2004 5:50 utc | 12

Hey Fran, I hope that Maria Laach was good for your health. 🙂

Posted by: teuton | Aug 2 2004 8:15 utc | 13

I am just back from a week in training in Ayurveda with Doctors, healers and Body workers from the US, Germany, Holland, Lettland, etc. and many interesting talks. I feel once more confirmed in own belief that our health care system itself is sick – and working only on the symptoms will in the end bring no improvement. There is a big change needed, not only in the US but also in most Western countries.
First, we need a definition of what health is. In allopathic medicine, health is still defined as the absence of illness. But what is health really? Health is more than just a smoothly running body, it is also emotional and mental and yes, also spiritual wellbeing. With this, I mean a feeling of connectedness and belonging that has nothing to with church or religion.
Before I continue, I want to mention that I am aware that not all physicians are part of what I am talking about below; however, because of this their work often becomes more difficult. In a training I did, I had to read to read ‘The politics of cancer’ by Samuel S. Epstein, a report for written for the US Congress, and another book ‘When healing becomes a crime’ by Kenny Asubel.** They confirmed what I have been suspecting; the medical establishment is a Mafia – very greedy and power hungry.
The first step I consider is to define health in a more holistic way. This would include the environment, because no doctor will be able to make us healthy if our environment is becoming poison for our health. Clean food, water and air are essential to health. Then there is the lifestyle – I do believe that countries that have basic safety nets are healthier, like social democraties. Unfortunately, most governments are trying to cut them down.
Then very essential something that teuton mentioned too – health education, but not just how the body works, but also how the human being is part of the planet and how every action has an effect on it, because of cumulation. Again and again I am amazed how little people know about their own body and how it works. They often know more about their car and also take better care of it than of their own body. If you do not know how your body works, how can you control and evaluate what your doctor tells and recommends you. Through knowledge we can become more responsible patients. I have learned over the years that each individual has much more control over his/her health than we believe. However, often people are not willing to make the changes necessary to stay balanced and healthy. It is easier to leave the decision to the doctor an pop some pills.
The allopathic medical establishment today is intimately connected with the big Pharma industries, which are trying world wide to control access to food and medicines. I do know that in the EU they now want to put herbs in the hands of doctors only, also vitamins should be sold by doctors only and not over the counter anymore etc., etc.. It is interesting that this medical mafia at first laughs at every alternative treatment. Then when they see that money can be made with it, it is declared dangerous and that it should be used by medical doctors only. I don’t have the study anymore, but a few years ago, the people in the US spend twice as much of their own pocket for health, than was spend by all health insurances together!!!
What can be done to change the system. Well, first of all we can make changes in our thinking and lifestyle – this is in the power of each person. Where as the change of the system is more difficult. But again, here too we can choose the health practitioners accordingly. Holistic medicine would never have become more acceptable if not a lot of people would have switched to it. So our personal choiches affect the whole. There is now in the US even a FDA? for research into holistic treatments. And then there is also the political part. Support politicians that support different medical approaches, and maybe for the environment the green party and so on.
I hope my comment makes some sense, as this is such a vast topic and there is so much more that could be said and done, but my time at present is limited. I know this sounds idealistical – but I think over time it is possible. Our health care systems might be able to run for a few more years on artifical life support, but than it will break down – that will be the change to bring basic change to it.
** Caution: reading these books might be hazardous to your bloodpressur and emotional balance.

Posted by: Fran | Aug 2 2004 12:27 utc | 14

@ teuton
yes, it was great, beautiful spot. If you ever have a change to go their, it is really worthwhile.

Posted by: Fran | Aug 2 2004 12:30 utc | 15

@ teuton
yes, it was great, beautiful spot. If you ever have a chance to go their or need a break from your project, this is the place to regenerate.

Posted by: Fran | Aug 2 2004 12:33 utc | 16

Sea sickness
Fran, this article, unfortunately, has a direct bearing on what you are saying I think…
The world’s oceans are sacrificing themselves to try to stave off global warming, a major international research programme has discovered.
Their waters have absorbed about half of the carbon dioxide emitted by human activities over the past two centuries, the 15-year study has found. Without this moderating effect, climate change would have been much more rapid and severe.

But in the process the seas have become more acid, threatening their very life. The research warns that this could kill off their coral reefs, shellfish and plankton, on which all marine life depends….
Seas turn to acid as they absorb global pollution
There is little point in seeking ‘health’ while the very world that gives us life is made sick.

Posted by: Nemo | Aug 2 2004 13:04 utc | 17

Nemo, you know, the key has been said before. It’s just that people weren’t listening and weren’t taking this seriously. Because otherwise the cognitive dissonance would be too strong for their feeble brains.
Though, if you want the naked truth, here is it:
Every mammal on this planet instinctively develops a natural equilibrium with the surrounding environment, but you humans do not. You move to an area, and you multiply, and multiply, until every natural resource is consumed. The only way you can survive is to spread to another area. There is another organism on this planet that follows the same pattern. A virus. Human beings are a disease, a cancer of this planet, you are a plague.

Posted by: CluelessJoe | Aug 2 2004 13:52 utc | 18

@Fran,
I summarize your post of 8:27 AM as follows:
Lets define health and in a more holistic way
The medical establishment is a Mafia
Personal knowledge is essential to good health
The system will try to usurp whatever is working for we the people but not making them money.
Support politicians that support different medical approaches

The last is a good suggestion. I pledge to try to be that kind of politician if elected.
But then NEMO’s valuable link stating that:
world’s oceans are sacrificing themselves to try to stave off global warming…
There is little point in seeking ‘health’ while the very world that gives us life is made sick.

adds another degree of complexity to the situation.
I’m leading up to something here.
This morning on VPR (VT public radio) I heard Joe Trippi, Howard Dean’s ex campaign manager state:
” the country is entering an age in which empowerment of the people, rather than control of information by the elite, will be king. He said Americans are becoming fed up with the top-down society and that a “huge sea change” is coming, perhaps as soon as Nov. 2, Election Day.”
I not only hope he is correct. I am being more and more inspired to act as if this is the truth. I don’t see any other effective way to work toward a day when we will be regaining our health and the health of Gaia. I am inspired by and effectively informed by the old Whiskey Bar patrons and Billmon.
There is a major change that is going to have to happen in the near future, a bifurcation. We at this blog are among the butterflies out here that are flapping our wings and our combined effect is accumulating. There is hope and I salute all here for your continuing effort. Lets all keep on flapping even when we feel totally oppressed by the forces trying to thwart our efforts. My last sentence is very much directed at me. Y’all here give me a chance to articulate what would otherwise just be passing thoughts.
Aloha

Posted by: Juannie | Aug 2 2004 15:34 utc | 19

Nemo,
it is not only the sea that is suffering, but also the sky. For the last three years I have observed those strange trails by airplains, which dissolved over time into feathery clouds and could not find any meteorological or other explanation. Then a few months ago I was given an article about chemtrails. Unfortunately it is in German and I have not been able to find a link to the magazine ‘raum & zeit’ where it has been published in January. But this article explains exactly what I have been observing. I remembered the article in the Observer Giant space shield plan to save planet . What was not mentioned that apparently they are already spraying. If this is correct it is aluminum and bor. Now aluminum is considered as a possible cause for Alzheimer. I still hope that this is not true, but while I am writing this comment I can observe two airplanes leaving trail. I have learned now that these planes fly to low for condensation trails. I looked it up over Google and found 32’000 links!!! Unfortunately many are loony toon and tin foils hat sites and I am not yet willing to go that far. I am not very good at searching – so I was wondering, considering your skills for finding all those great articles, if you would search for some good more scientific sites
I have the site for the patent that is the foundation for this concept, for those interested in more scientific information.
patent Stratospheric Welsbach seeding for reduction of global warming
Abstract
A method is described for reducing atmospheric or global warming resulting from the presence of heat-trapping gases in the atmosphere, i.e., from the greenhouse effect. Such gases are relatively transparent to sunshine, but absorb strongly the long-wavelength infrared radiation released by the earth. The method incudes the step of seeding the layer of heat-trapping gases in the atmosphere with particles of materials characterized by wavelength-dependent emissivity. Such materials include Welsbach materials and the oxides of metals which have high emissivity (and thus low reflectivities) in the visible and 8-12 micron infrared wavelength regions.

more informations on chemtrails
and pictures
Stolen Skies: The Chemtrail Mystery – Jet Trails in the Sky Used to Disappear. Now they Linger.
If this is true, and I still hope very much it is not, this is a desaster in the brewing. The most frustrating part is the secrecy connected to it.
Juannie,
I hope you get elected, people with your openness to these problems are badly needed.

Posted by: Fran | Aug 2 2004 19:15 utc | 20

I wasn’t aware of the double posts at 8.30 – I thought the first one was deleted. Sorry

Posted by: Fran | Aug 2 2004 19:20 utc | 21

As tempting as it is to worry about everything in a sort of general way, this is still the best argument for universal coverage.
Until we have universal national coverage, there will be no single voice pointing out the real costs of mistaken policies.
The best illustration of this is the current private-practice M.D.. We get nothing from these people- they don’t even report medication problems reliably, and will happily ‘treat’ problems caused by pollution as long as individual patients will pay, making no move to prevent the pollution itself.
Compare that with the British NHS, which routinely reminds Parliament that real costs will result from pollution, lack of prevention, or poor regulation.
Universal healthcare can’t make people feel as well as they will feel if they ride a bicycle every day. However, universal care can remind lawmakers that roads without bike lanes have real costs that have to be paid.
Universal healthcare does not mean universal solutions. In fact, as such healthcare is developed, we’re going to learn that some situations do not lend themselves to universal solutions. Our experience with marijuana prohibition should be a strong clue about what not to do.
But we can and should expect universal healthcare to put a chokechain on a ‘healthcare industry’ that is devouring our productivity faster than the demon rum ever did. It’s not an unreasonable demand.

Posted by: serial catowner | Aug 2 2004 19:57 utc | 22

serial catowner,
I do live in a country with universal health care, and the premiums for insurance and for health care are still soaring and many problems are not being solved. I agree that everyone should be covered – but I am convinced it will not solve the problems that are the cause of disease and until these are are adressed the cost will continue to rise. Universal health care is just a band aid, but not a cure. Sooner, hopefully, or later these problems will have to be adressed if there is to be real change.

Posted by: Fran | Aug 2 2004 20:08 utc | 23