Don't treat the old and unhealthy, say doctors

[The Straight Story]

Don't treat the old and unhealthy, say doctors

By Laura Donnelly, Health Correspondent
Last Updated: 11:52pm GMT 26/01/2008


Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives.

Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.

Smoker - Don't treat the old and unhealthy, say doctors
£1.7 billion is spent treating diseases caused by smoking, such as lung cancer and emphysema

Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state.

The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "out­rageous" and "disgraceful".

About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt.

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=FL15VKW5APDC5QFIQMFCFGGAVCBQYIV0?xml=/news/2008/01/27/nhs127.xml

[Mythsaje]

1. Hell, maybe they should just deny any operation

to anyone who's over the average human lifespan for the region. They've lived a full life and the resources can be better spent on younger, healthier folks.

:sarcasm:

[roguevalley]

46. I hope all doctors there become old and unhealthy. what then, docs?

ya nazis

[aquart]

2. Give 'em soma and let 'em die.

[seriousstan]

3. Soma, that's how I got old and unhealthy....YES ..give me soma.

[Echo In Light]

23. Quinolones/fluroquinolones {common;y prescribed 'new' antibiotics} are poisonous too

[SeattleGirl]

4. On behalf of my mother, myself, and my family, I say:

FUCK YOU!!!

I'd like to see them make that same decision when it come to their own family member.

Fuck them to hell!!!

[Lasher]

5. Sounds like the 45-1 Retirement Plan

One 45 caliber bullet, right in the head.

[Yavapai]

35. when the hospital/doctor refuses treatment to my wife,

that .45 won't be to my head!!!

[Lasher]

36. Yes, that would be the classic Postal Retort. n/t

[countryjake]

6. That old "bootstrap mentality" will soon seep into every aspect of our lives.

Blame the sick for getting ill, blame the hard workers for not working hard enough, or, like over here in our country, blame Americans for having the "American dream". I'm so sick of hearing how we all have to "own" the mistakes we've made in our lives and need to "pay the price" for our poor choices. This involuntary Do Not Resuscitate bullshit is killing us all.

[Swamp Rat]

7. A newer, kinder eugenics.

sieg heil!

[BlueIris]

9. Yeah, no kidding.

[mtnester]

10. Gotta have the green on Tuesdays next I guess

those of you of a certain age will get this reference.

[TreasonousBastard]

8. The kneejerkers aghast at this might note that...

this is a british discussion about the limits of single-payer healthcare.

It is the sort of discussion that we have to have, too, since healthcare does not have infinite resources, and under single payer those resources could well be stretched thinner.

It's not simply about letting old people die, but about elective surgeries on 90-year olds just because someone will pay for it. It's about alcoholic baseball players getting one of the few livers available.

We now have medical technologies to extend life to where it could be argued life has no business being, and have to face the financial and ethical ramifications of heroic measures to keep the doomed alive for a few more weeks.

Didn't we already argue the principles of this a while back when a great Senatorial doctor diagnosed someone over TV?

[melody]

11. It's not about 90 year olds ... eventually it'll be about 12 year old poor kids

It's the way these monsters think. It's there in their writing -- "why care for the children of the poor?"

This just opens the door to it.

[TreasonousBastard]

16. That might be, but it's something to fight against. We still...

have to work out ways to distribute limited resources. And we have to humanely decide what treatment is excessive.

[melody]

18. No, I think we have to find a way to drastically reduce the costs of medical care itself

Not the number of patients. And what may seem "humane" to a sociopath, wouldn't seem "humane" to his/her victims.

[malaise]

19. Bingo

first they came for.....

[China_cat]

55. Look at Texas

it's already about newborns and anybody else without insurance. How many posts have we seen about this right here in the last year?

[DadOf2LittleAngels]

97. This is national single payer healthcare... Period...

There has to be a better road than the two extremes and I hope for our society we find it..

[LeftCoast]

12. There is a fairly common assumption around here that single-payer

is a cure for everything that ails our HC system. Unfortunately, all single-payer does is address who is paying. It doesn't address what gets paid for. Those who rail against insurance companies denying coverage for a Rx or treatment may be shocked to learn that also frequently occurs in single-payer situations as well.

[TreasonousBastard]

15. That's been my argument for years, and that...

universal coverage is not synonomous with single-payer, as the French and Germans have discovered.

[Lasher]

30. I am a strong proponent of single-payer

And I certainly don't think it would solve all our health care problems. Such an assumption would be far too sweeping. It would make things much better, however, in two major respects:

Elimination of bureaucratic inefficiencies and profit-taking by insurance company middle men would significantly reduce costs - enough to cover everyone for no more than we are collectively paying today.

Insurance companies have an incentive to deny claims because this is a way they maximize their profits. This motivation would be reduced if claims were handled by a government agency.

[DadOf2LittleAngels]

99. I have a nit to pick

"Elimination of bureaucratic inefficiencies" Sorry but I have worked for government agencies and private insurance companies. Guess who's more bureaucratically inefficient?

"profit-taking" You might have a point here but many of the big providers (like the one I work for) are non profit and by law in some of the better providers (like the one I work for) put 90% of their income into paying premiums. With much of the rest going for infrastructure investment and other growth initiatives. I think a law against profit taking by insurance companies on a national scale (like setting a minimum % income to be used towards claims and a maximum % for payout) would work.

[KansDem]

102. Oh, I don't know...I suppose we all have our horror stories...

Guess who's more bureaucratically inefficient?

I suppose you're referring to government, but when I have to endure a open wound painfully for seven weeks before I can see a specialist because "he can't see one more patient" the next day, and when I'm denied access to see my doctor for a six-month checkup after suffering a heart-attack because I "didn't have exact change" for my co-pay, and when my toddler wakes up one morning with a 104-degree temperature and I'm told by my doctor's office that "the next appointment is in three weeks," then I wonder who's "more bureaucratically inefficient."

I suppose it's all in how you define it, and if you believe in maximized profit while thinking of the patient as only a number, then I agree the insurance companies are more efficient based on actual experience.

[DadOf2LittleAngels]

105. ANd in englend they are talking about who to let die...

"I suppose you're referring to government"

Yup

""didn't have exact change" for my co-pay, and when my toddler wakes up one morning with a 104-degree temperature and I'm told by my doctor's office that "the next appointment is in three weeks," then I wonder who's "more bureaucratically inefficient.""

Does not sound like a problem with your insurance sounds like you have crappy doctors. My insurance is certainly no premium plan and yet if I had to get in to the doctor today for a 104 temp I could get in today or more likely give my kids some Tylenol and take them to the ER or urgent care.

Dude when I was leaving NY state (not the govt I worked for) it took *two hours* to turn in my license plates! Two hours to hand someone two dollars and drop my plates in a bin! The govt is far more more bureaucratically inefficient. If they cant run the DMV well I dont even want to imagine how badly they would mess up health care.

The system is clearly broken but to say the govt would be doing it better is, to say the least, a stretch.

My mother is on medicare and finds it far harder to get things approved and taken care of than it was before my father retired.

"I suppose it's all in how you define it, and if you believe in maximized profit while thinking of the patient as only a number, then I agree the insurance companies are more efficient based on actual experience."

Like I said my company puts 90% of every dollar that comes in the door towards paying claims, the rest pays staff and improves the systems to make them more available. I have been working 70 hour weeks the past month or so to implement a system which will make it even easier for doctors offices to get claims processed (that more efficient) and as a salary employee Im not getting paid for my trouble, the most Ill get is a week or so off when this project is done. When I worked for the govt the rules would not let me go the extra mile in this manner.

--

BTW if the 'exact change thing is true its the doctors office which is fubar and I would report them to the better business bureau before my next post on du ;) Sorry to hear about your troubles.

[Lasher]

107. OK, fair enough.

Then can you explain why the US spends almost twice as much per capita on healthcare as Canada?

If the Canadian system's key features--universal coverage, a single payer, and systemwide spending controls--were applied in the United States, the savings in administrative costs alone would be more than enough to finance insurance coverage for the millions of Americans who are uninsured.

General Accounting Office, June 1991

A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Doctors and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules - often rules designed to avoid payment. During the transition to an NHI, the savings on administration and profits would fully offset the costs of expanded and improved coverage.

Physicians for a National Health Program

[DadOf2LittleAngels]

111. Because the market will bear it..

It has nothing to do with Canada being (a) more efficient with their resources or (b) having more resources. Its about the fact the same bottle of pills that cost 10$ there can cost 200$ here and that has nothing to do with the government paying the bill, its about the government not stopping price gouging.

Correlation does not equal causation.

"A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry"

Trust me on this, in the end it will cost more to have the govt do it. I used to work for USACE and they stopped doing their own dredging some time ago because it cost them more in administrative cost than it would for them to hire someone else and then just do oversight (and I was a PITA as a safety inspector).

Your numbers say 150 Billion lets look at how to save more

"the difference in inflation-adjusted per capita expenditures on prescription drugs between the 2 countries grew from approximately $31 to approximately $356 (year 2005 Canadian dollars)."

reigning in the obscene cost of prescription drugs in the US would save at least 100 Billion laws which strongly regulate the payout percentage of *gross* income would add well over 150 Billion. I am *not* saying there is not price gouging going on and its multi-factoral; it aint just the insurance companies... The industry can be regulated far better..

Also life expectancy is a *terrible* measure of how good a medical system is. Many other factors feed into that including violent crime, substance abuse, miles traveled by car, ... The average life expectancy of a fisherman is far lower than mine does that mean my health care is better?

[Lasher]

113. The market is getting tired of being exploited

You say it has nothing to do with Canada being more efficient with their resources. I say you're wrong and the General Accounting Office agrees with me.

Prescription drug prices in the US are another symptom of privatization gone wild, and of inordinate pharmaceutical corporations' influence. You are trying to argue that this, instead of additional administrative costs associated with insurance industry involvement, is the reason our per capita health care spending is so high. But this is a false dilemma; both are contributing factors.

You say life expectancy is a terrible measure of how good a medical system is. I say average life expectancy is a good indicator, and the World Health Organization agrees with me. We are not comparing your life expectancy with that of a fisherman. Canada has fishermen, we have fishermen.

http://www.who.int/whr/2000/en/index.html

I furnish facts and links to reliable sources. You share your perception based on your experiences and say, "Trust me on this...". Not a very compelling exercise in nit picking.

[DadOf2LittleAngels]

115. Correlation does not equal Causality

"You say it has nothing to do with Canada being more efficient with their resources"

If by more efficient you mean making a kid under this vonder-system wait years for an MRI follow up on cancer remission then yes they are great... If by efficient you mean creating a systems dangerously short on doctors today and at risk for a collapse of the doctor supply tomorrow then yes they are efficient.

"Prescription drug prices in the US are another symptom of privatization gone wild"

I would say lack of regulation and oversight not privatization, we had prescription drugs for years without the prices being as they are now and these companies sell to Canada far cheaper than the us market this could be solved by simple anti-price gouging actions.

"You are trying to argue that this, instead of additional administrative costs associated with insurance industry involvement, is the reason our per capita health care spending is so high."

Yup I am saying price gouging by many is the problem and privatizing the whole industry is killing a fly on your friends head with an ax. Use a swatter (regulation)! Some companies do it far better than the govt could some far worse..

"I say average life expectancy is a good indicator, and the World Health Organization agrees with me."

I dont care who agrees with you the fact is if violent crime in a nation is far higher than in another it *will* have lower life expectancy. Average only works if all else is equal. For instance look at obesity in the US vs Canada the per capita obesity rate in the US is *FAR* higher than Canada, the risk of dieing because of violent crime *far higher*, the percent of people exposed their whole lives to crap air *far higher*.... Are you getting the picture?

Sorry, you can post a stat but stats one one of the three great lies..

Lies, Damn Lies, and Stats... Stats being the worst because people assume they are gospel.

You want facts:

http://www.nationmaster.com/graph/hea_obe-health-obesity

1 in three Americans are obese vs one in seven Canadians

So yea they have fat people and we have fat people but we have double the number of fat people per capita this means higher rates of heart disease, stroke, and dozens of other conditions.

http://www.nationmaster.com/graph/cri_mur_percap-crime-murders-per-capita

in the us 4 people for every 10,000 are murdered every year, in Canada 1 person per every 10,000 is murdered Americans are four times as likely to be murdered.

http://www.nationmaster.com/graph/cri_mur_percap-crime-murders-per-capita

in the us 4 out of ten thousand die accidentally by being crushed, in Canada its less than 1 in every 10,000

...

I tried to give you a simple example so you can understand what the stats mean, because without a full understanding of what the numbers are and what populations they represent saying that x means y is foolish...

[Lasher]

118. Correlation is not causation but it sure is a hint

My statistics from unimpeachable sources is met with your unqualified rejection:

I dont care who agrees with you...

Sorry, you can post a stat but stats one one of the three great lies..

Lies, Damn Lies, and Stats... Stats being the worst because people assume they are gospel.

And yet in the very same response you submit statistics for inclusion in our debate?

I appreciate your trying to keep it simple so that even I might have some hope of keeping up. But if it is foolish of me to say that x means y, how should I react when you offer just such an argument? Are you uniquely qualified to make such an assertion because you have a "...full understanding of what the numbers are and what populations they represent..." and I do not?

Maybe you should apply your 'Correlation does not equal Causality' slogan to yourself. Murder rates and obesity contribute to life span averages. So does access to medical care, which single payer UHC certainly improves. Yet you ramble on with another false dilemma, trying to say that if high murder rates and obesity diminish average longevity, lack of access to medical care can not.

Although we spend more per capita on health care than any other country, the US now ranks 45th in longevity.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

Do you think this is because there's no fat people in any of those 44 other countries, or that we're the only ones who murder one another? Or maybe you think Americans are the only people on earth who get crushed to death by falling pianos or whatever.

[Rosemary2205]

22. Recommended for your post.

Healthcare is going to rationed in some fashion or another. People either self ration or someone else will have to do it.

My father is dying of colon cancer. There is a very new drug intended for another type of cancer and some oncologists have been using it off label and had a little success. Medicare nor AARP will pay because it is off label. It will cost about $50,000 for just the pharms, and is likely to only entend his life for 3 or 4 months. My dad has decided it isn't worth that kind of money to just be sick from chemo all the time for another 4 months, drain mom's finances and still die anyway. The truth is, if Medicare would have paid he might would have tried.

There are very difficult questions to ask. Do we spend $100,000 or more for an emergency bypass on an 87 yr old man who has emphasema and refuses to even cut back on his 3 pack a day habit? ( I know this person) Do we give knee and hip replacements to people more than 100# overweight no questions asked or do deny it and we have them demonstrate a willingness do lose at least 20% of their weight first?


You are absolutely right. This is a discussion we HAVE to have.

[Lasher]

32. I agree with you.

It's not pleasant to consider these things under single payer UHC but it is necessary that we do. But to me that is not as uncomfortable as contemplating a system where the rich live and the poor die.

[zorahopkins]

56. Another Question....

"There are very difficult questions to ask. Do we spend $100,000 or more for an emergency bypass on an 87 yr old man who has emphasema and refuses to even cut back on his 3 pack a day habit? ( I know this person)"

My question about such a patient would be this: "Why is this person even a candidate for surgery?"

Someone who is 87 with emphansem, and who needs an emergency by-pass, will, I think, most lilkely die from the surgery itself.

His/her heart is probably too weak to stand the trauma of surgery. And, if his/her heart could stand the sugery, then it is amost certain that his/her lungs would not be able to survive the surgery.

[Billy Burnett]

57. Keep in mind that the costs in your dad's case would be much less in a single payer system

So, the decisions would be less onerous.

Sorry about your dad. :hug:

[DadOf2LittleAngels]

100. But that should be a personal decision...

When my grandfather was fighting cancer he was denied Chemo in Canada so he came over to the sates. It extended his life about a year in that year he had a set of birthdays for his kids and grandkids, holidays, an anniversary for his wife of almost 50 years, saw two more grand kids born, and the seasons change. It was a remarkable year and at 14 I got to know my grandfather and he got to know me.

"There are very difficult questions to ask. Do we spend $100,000 or more for an emergency bypass on an 87 yr old man who has emphasema and refuses to even cut back on his 3 pack a day habit?"

There are only two times treatments should be denied

1) Organ transplants to people who will in short order destroy the organ (and should the research at the U of M work out this would still be ok as you could grow an organ)

2) The procedure is far more likely to kill the patient than extend his life (and even then if the guy only has a few weeks anyways w/o why deny him)

"Do we give knee and hip replacements to people more than 100# overweight no questions asked or do deny it and we have them demonstrate a willingness do lose at least 20% of their weight first?"

Well given a hip replacement is not life saving I think laying the line on (you have to show you want the lifestyle this hip is supposed to provide) is ok..

[Oak2004]

26. Funny this conversation isn't being held in every nation with universal healthcare

just the ones with underfunded healthcare and imperialist ambitions.

[kineneb]

31. class raises its ugly head

figures this is from the Brits. Yes, all medical systems need a triage system, but this sound very harsh and inhumane.

More of that "Puritan/Calvinist" stuff. "If you are fat/sick/poor/disabled, it shows you are not of God's elect, so just go off and die, worthless creatures." Hmm, sounds rather un-christian to me.

...goes off to grab NT and Gospel of Matthew...

[AngryAmish]

45. It is held in every country with universal healthcare

Resources have to be rationed, even in Kuwait or other countries awash in petrodollars.

Price is a rationing mechanism, nothing more and nothing less. Most of us have decided that price rationing is immoral way to limit healthcare resources. If so, then the rationing has to come from a different mechanism. If limiting healthcare to old, self-sick or other measures, then that is one way.

[DadOf2LittleAngels]

101. huh?

France has this discussion, England has this discussion, and Canada has this discussion (Canada has sent a few hundred people to the US because of limited resources).

[NashVegas]

43. About Alcoholics and Livers

David Crosby is still alive and doing fine, last I heard.

[melody]

58. As is Larry Hagman and numerous other famous liver recipients

The problem, as ever, isn't the alcoholic patient, but the poor alcoholic patient.

My mother died at 52 from liver disease caused by alcoholism. She might be saved by the current state of
hepatic medicine. No matter what someone's opinions of the alcoholism, her continued life would have kept my
15 year old sister from growing into womanhood without her mother in any form.

It's so easy to make these decisions when it's in the abstract. The HMOs have found that out.

[Skittles]

70. lets deny treatment to everyone who doesn't exercise

how about that? That would save tons of money :o

[LWolf]

77. "the old" is not restricted to those too feeble to function.

Even if it was, that's a decision best made by a patient, his or her family, the family doctor, and perhaps a living will.

I say this as someone who once defended a 99 yo family member from an invasive procedure in the hospital. I wasn't legally in charge; I had to kick up a big fuss and I stood physically in the way of the people trying to approach the bed, hoping my mom, who had legal guardianship, would show up soon. My great-aunt, the woman on the bed, had long since succumbed to dementia. We already knew what was wrong with her; she had an untreatable tumor. Untreatable without killing her in her feeble state.

She, in her dementia, thought the doctor who came in to give her a pelvic exam was trying to rape her.

Meanwhile, there are plenty of "old" people who still function. My mom had an elective procedure done just this week to her hand. That elective procedure will allow her hand to function. It cost a lot out of her budget. Not every hmo considers hand function to be necessary for senior citizens.

[melody]

13. When the wealthy and powerful start deciding who lives and dies, we're ALL at risk.

Not "just" those awful fat people and old people and sick people.

Then to where do they go ... the less intelligent? The less attractive?

[flashl]

14. Exactly, once the barn door is fully open, there is no retreating. n/t

[LeftishBrit]

17. This comes from a very right-wing British newspaper (the 'Torygraph')

It is very unlikely that the NHS will ever ration treatment according to moral judgements of people's lifestyle choice; but it may ration treatments according to their likely success in relation to their cost. And once cost considerations enter the equation, a lot of dangers do as well.

www.saveournhs.moonfruit.com

[MrScorpio]

20. This is a perfect approach for treating human beings...

IF you regard them primarily as SLAVES

[TahitiNut]

29. Exactly. It's a symptom of wholesale objectification of human beings.

Racism, sexism, labor exploitation, spousal abuse, and a whole host of pathological attitudes find their roots in the objectification of human beings. When we're treated as a commodity - or labor is treated as a commodity - we're deeply and seriously corrupted.

[NashVegas]

44. Unless You Are Willing to Go Back to An Agrarian / Artisan /Tradesman Economy

We're nothing more than a labor resource for people who own that 90% of the assets.

http://en.wikipedia.org/wiki/Enclosure

[bean fidhleir]

74. It wouldn't be "go back". Getting rid of corporations would be an *advance*

If you mull it over, I think you'll have to agree that our problems ALL stem from the ability of a few to amass more than their share of wealth and power.

[bean fidhleir]

21. Easy solution

Namely: nobody can buy healthcare that's not available to all. If anyone will be denied tax-paid healthcare because, e.g., they smoke, then make it a criminal offense for any smoker to obtain that healthcare privately anywhere in the world.

The moment it becomes obvious to the wealthy elites that they can't get unless everyone can get, all barriers will magically vanish.

(It's essentially Smedley Butler's remedy for war: make sure the warmongers and would-be profiteers know that they will immediately become infantry privates in the front lines)

[undergroundpanther]

65. Exactly

If fat people can't get health-care than rich parasites won't get it either!
That's the rub about elitists they think they are entitled to be treated as special or worth more, than you or I..Everytime it is their own class holding the worthiness sticks,against others. And it's with those same old social darwinist self serving measuring sticks that they tell themselves they are entitled to what others must be denied because they are better than the rest of us.What bullshit!!..Elitism is a LIE, all a ruse to let the rich live better at everyone else's expense,to protect the lifestyles of those who call themselves elite.

The illusory classist mentality is created by actually,deliberately DEPRIVING others of what they need and telling OTHERS how unworthy they are of getting things the rich get for no other reason than class..

I think Fairness is the antidote to elitism. Ronnie raygun got alzhiemers all of a sudden the elitists were concerned..,Because one of THIER class got it. Fairness is like this: if one goes without we all go without. That is called being FAIR.

And elitism HATES being fair because when things are fair the elitists have nothing distinctive to claim about themselves and how better they are ,they can't claim they are special so they realize they are not entitled.. Exclusivity to access fades when everyone else has some too.Elites HATE fairness.

Taking the elitism apart is about making elitist assholes accountable for being UNFAIR,makes them face the fact there is no such thing as elitists in a human race.
Things are either unfair or fair,family name,money,and status have no bearing on fairness if it is truly fair..
Lets make things more fair,and destroy the toxic beliefs of elitism at it's greedy insecure,core. Welcome to the human race ex rich parasite,Time to grow up,get in line and wait your turn like the rest of us.

[bean fidhleir]

75. *Well* said!

Pity there isn't a way to recommend an individual post.

[originalpckelly]

24. Bureaucracy is the problem, and it doesn't matter if it's corporate or otherwise.

The cold and inhuman calculations made about people are the natural result of a cold and unfeeling system. It's very easy for someone you don't know to not give a fuck about you. That will be true in a corporate or government bureaucracy.

[Junkdrawer]

25. There's a serious discussion buried here somewhere...

The fact is that as medical technology advances, heroic treatment cannot be given at all times to everyone.

So, do we discuss how we are to allocate resources and come to an open, equitable allocation?

Or, do we leave it to chance (or The Market) to decide?

[Oak2004]

27. Except you might need to notice that the people targeted for denial of less-than-extreme treatment

are those which society has been riled up against (and those, incidentally, more likely to be poor), not those with poorer outcomes. You'd have to determine the issue of poorer outcome on a case-by-case basis, not a sweeping generalization, for one thing.

For example, few people who don't follow the subject realize it, but there's never been conclusive evidence that obesity shortens lifespans -- and that's not my opinion, or the opinion of fringe researchers, that's the opinion of major groups and agencies often in the lead on generating the obesity frenzy (but you need to read the fine print to find this out). It seems that when you start controlling for other factors like exercise level, other health conditions, etc., it becomes much less clear that obesity shortens life at all.

If obesity is not clearly associated with early death, why then target obese people for early death? I mean, other than that obese people depending upon government healthcare are almost certainly from the disposable classes?

Rinse and repeat for most of the groups targeted (cigarettes excepted, though even that has a working-class bent, and rich smokers would continue to get their health care under such a scheme).

[Junkdrawer]

28. My contention is that the abuses you cite are more numerous if....

decisions are made in private than if guidelines were rationally and openly discussed.

[Oak2004]

91. Oh, the abuses are very much alive and well

Disabled people, for example, are routinely denied medical treatment because doctors believe they don't have "quality of life", even though virtually every study shows they (we, I should say in my instance) have at least equivalent quality of life to nondisabled people (and some studies show we have a higher quality of life).

I'm not sure, though, that the "debates" have not been held out in the open -- so-called medical ethicists have been openly advocating denying health care to disabled people for years, and few outside of an outraged disability community have been paying attention.

The fact is you can't determine "poor outcome" with a broad brush. Determining that requires taking into consideration a specific patient's overall health. Broad-brush determinations are, quite simply, discrimination.

[Spiffarino]

37. Dick Cheney would be dead were it not for his money

To add to the serious discussion about universal health care:

• Should money - or lack of it - be the basis for deciding who gets to live a little longer?
  
• Should smoking, drinking, drug abuse, etc., be an excuse to deny critical care and...
  
• ...should a wealthy obese person or addict be denied care even if the bill can be paid?
  

It's not just about unhealthy lifestyles and people making bad choices; it's also about fairness. While it is important to recognize that it may not be possible to cover everyone if we include those who have bad prognoses, does that mean a doctor or hospital shouldn't treat those who have the means to pay for their own treatment even if they are likely to have bad outcomes?

This is an extremely important and difficult issue, and it's a debate we must engage in if we are going to fix our miserably broken American healthcare system.

[Vanje]

53. HIS money?!!??

Dick Cheney has'nt spent a cent on health care.

Thats OUR money, being spent to keep his shrivled dark heart beating. Dick Cheney gets 100% government supplied health care.

[Rex]

33. Money decides who lives and who dies. No matter what the equation

money, ultimately, is what humans base everything on.

Sad, pathetic, wrong.

[halobeam]

34. There is something really wrong with this type of thinking.

I know people with MS that don't do the things they need to do to maximize their health. I know people with diabetes that don't do the things they should do either. Patients that have minor heart problems still are eating the things they shouldn't. What about the mentally ill that miss many therapy appointments?

Who is going to watch them? Will their doctors report them to the proper authorities? If the law directs them to, will the patients be honest with their doctors? I doubt it.

Many people don't exercise, and eat right. Many are in high risk of getting certain diseases, because of genes, because of lifestyle, etc. What will happen to them?

Already there are measures in effect to keep count of what you buy in the store. Will an alert go off if a heart patient buys unhealthy food on a regular basis?

Oh brother, Big Brother... how many people will hide in a shipping container to get the hell out of here, in hopes of living better in another country? And when?

This is a picking off process, who gets to choose?

Why not pick apart the measures of the system that fail the people instead of the measures of the people that fail the system.

[Mitsuko]

38. Need to know more specifics

This article is very vague in terms of what is meant by withholding treatment. Medical tx can encompass from anything as benign as supplemental O2 via nasal cannula to invasive procedures like open chest surgeries. For example, unless it's a life-threatening situation, we don't put smokers with concomitant medical illnesses on the OR table. Same thing goes for the mobidly obese. There's a much greater chance of them dying from surgeries, or controlled violence if you will, due to effects of anesthesia on the CV system.

My experience is that a lot of the time, it's a miscommunication between the healthcare team and the patients' families. We as a society need to be educated on the implications of technological advances on prolonging life, and consequently quality of life. Do I think it's selfish for parents to keep alive their severely mentally and physically disabled infant with a Grade III hematoma through longterm, invasive means at all cost and regardless of that baby's grim prognosis and suffereing? You bet. Do I think insurance or the lack of it should determine which patients receive the most advanced care and treatment available? Of course not. A year and a half ago, I, in conjunction with the healthcare team, made the difficult decision to put my mother on palliative care, and she was able to die with dignity two days later. She had complications resulting from advanced Lymphoma and would have died on the OR table had we gone through with further surgery in attempt to prolong her life. It was the hardest decision I'd ever made in my life because from an emotional standpoint, she was young and I wanted her to fight on, and she was my beloved mother whom I was very close to. From a medical point of view, I knew I could not in good conscience put her through any more suffering.

So long story short, I think the article should not only stir debate on socioeconomic component of healthcare, but also the issue of medical ethics. Who gets care, why, when and how. We spend more on end-of-life healthcare costs than we do on preventive care, and I do believe universal healthcare will help curb this trend.

[Joanne98]

39. All doctors today care about is money and golf!

We have had over a generation a people deciding their careers by how much money they'll make. We now have millions of doctors who don't like people. We need to go back to wage and price controls. Get rid of the "selfish gene" and give the industry over to doctors who CARE about being doctors! Can you imagine one of these selfish shits taking a chicken for payment like they used to do?

[ACapsizingBoat]

50. What's really repulsive though is that they pretend to care.

[pinto]

66. I disagree. I see a few docs, have a fairly high need med condition,

they all take Medicare as full reimbursement - and they care.

[BlueIris]

68. There are a few half-way decent ones, but most are inhuman,

misogynist, racist fuckwads. As an ex-healthcare employee and child of a physician, (the kind who actually bothered to do his job) the hoards of slimy asshole MDs today just disgust me. I limit their access to me and my money as much as possible.

[Kixel]

40. Well...

I gotta add this-I'm a smoker. Why should the doctors give me a new lung if I am just going to continue smoking? In some cases, I think it is extremely realistic. It's different if they won't give me cold meds or treat me for a slipped disk, but if I know the risks and refuse to quit, why should I get replacement parts if I'm not going to take care of them?

Isn't this the way the donor list works now? I thought you had to convert to a healthy lifestyle in order to be considered? In addition, if I won't quit smoking and continue to damage my heart, shouldn't I be told I don't get a heart by-pass until I do?
I know what I am doing is bad for me-all of us smokers do. Yes, it is our choice, but there are consequences to some choices.

[Kixel]

41. Self Delete

Dup

[blues90]

42. Then just give me a pill of fast acting poison .

[woo me with science]

47. What's a "social abortion"?

Is that when you invite your friends and serve cheese?

[Hekate]

52. Why yes, I believe that would be it.

:rofl:

Hekate

[Cleita]

48. I guess they missed the poor, although they don't treat them

either or as little as they can get away with. It's okay with me. I'm ready to leave this existence. All I ask is that they give me enough pain killers to get through it.

[GCP]

54. They do treat the poor in Britain

That's the difference between there and here. :banghead:

[cgrindley]

60. This debate is about keeping health care free

a nationalized system cannot support the useless frills of the US system. It just doesn't work that way. Currently, they do ration health care, but they do it by manipulating waiting lists. This would simply codify the process more clearly. It's a good thing. People should be more responsible for their health. The elderly should realize that they do not get to live forever. That health care dollars (or in this case pounds) are better spent on the young.

[water]

64. Are you serious? That's disgusting.

Instead of you deciding where everyone's health-care dollars are spent, how about let individuals decide for themselves? You aren't a god, you know.

Under a free-market (far from what we have today, thanks to the Republicans and their campaign donors), if insurers don't want to cover smokers, the elderly, etc., there will be a huge untapped market for someone else to come along and fill.

[cgrindley]

73. How about this?

how about SOCIETY choosing to treat the individuals that are most deserving. That's how it works in a socialized health care system. It's not about the individual. The individual is not important. And that's why you Americans will never actually get free health care for all... because you want your system, just free. And your system is wasteful, bloated, litigious and preposterous. Remember that the majority of operations that will fall under these guidelines will be elective surgeries. That is surgeries that are not necessary. For example: Why should someone say... get a free elective surgery to correct a deviated septum if they smoke? They should fucking well quit if they want a free surgery to fix a deviated septum. And why should we pay for a 90 year old to have a double hip replacement? It is a worthless operation for the rest of us. Instead, use the valuable health care dollar to give free back surgery to the injured laborer.

And as far as providing livers to alcoholics... why? why should we do that? they should be at the very bottom of the list.

You know, we desperately need this system here. It works like a charm in Canada and the UK and the rest of Europe. Americans just need to get over themselves and think about the good of society as a whole.

[struggle4progress]

49. Insiders: Don't believe The Telegraph

[LeftishBrit]

79. HEAR HEAR!

They are usually accurate about concrete news items, though not always (e.g. they labelled Cynthia McKinney as a Republican!) but when they are discussing opinions, they often spin them in the right-wing direction.

The paper is often termed the 'Torygraph' and until recently was owned by Conrad Black.

It should be emphasized in any case that *no one here* is recommending not treating people because they are seen as a burden on society or having a bad lifestyle. Some doctors are suggesting that people should not get NHS treatment if other factors mean that the *prognosis* would be bad even with treatment. I think this has lots of dangers - e.g. one of my friends was born at 26 weeks when the viability limit was thought to be 28 weeks, and might not have survived if people had taken the 'bad prognosis' criterion too literally. However, there can be extreme cases: e.g. should public money have been spent on keeping Terri Schiavo 'alive', or on heart transplant surgery for a 95-year-old who would almost certainly die from the surgery itself?

[Bright Eyes]

51. The only reason a doctor should refuse to preform an operation

is if the risks out way the chance of recovery.

"First do no harm"...I guess they don't take that oath in Britain

[LeftishBrit]

82. But that is basically what their point is!

That treatment should only be given if the chances of recovery are good enough, and that one should avoid spending public money on treatments that are likely to be useless or harmful, either in themselves or as a result of the condition of the patient. Now I do think that there are big dangers in even considering the costs in such cases, and I oppose such policies - but no one is suggesting that certain patients should be excluded because they are less useful to society; only because their prognosis is seen as bad even with the treatment.

'"First do no harm"...I guess they don't take that oath in Britain'

This is *not* the actual policy in Britain; it is one suggested by a few doctors, and gleefully quoted by a right-wing newspaper.

[cgrindley]

59. Good thing... this is what I've been talking about

they already do this by manipulating waiting lists for operations... this would simply codify the practice. And good show. It needs to be done. You don't get to live forever. And free health care carries some responsibilities.

[FlyingSquirrel]

61. They should not treat accident victims who didn't wear a seat belt either.

:sarcasm:

[ThoughtCriminal]

62. Many insurance policies here exclude treatment for obesity

Ours does. Think about how counter-productive that is.

[Manifestor_of_Light]

117. Paying for liposuction and gastric bypass would pay for itself.

But no, they think every body that is fat eats too much. They blame the fat person.
They refuse to think about metabolic disorders, metabolic syndrome, glandular problems and such.

I already eat very little food and I exercise and I'm still fat. I have a very slow metabolism due to a dead thyroid, which started when I was 11 or 12. So gastric bypass would do nothing for me, because I don't eat too much. I eat far less than most people.

The only way for me to get rid of all the fat I need to lose would be liposuction.
I don't have health insurance anyway.

[Lydia Leftcoast]

63. Hey folks, when quoting a British paper, be aware that some of them are

the printed equivalent of Fox News.

The Telegraph, The Daily Mirror, The Sun, and (for more intelligent conservatives) The Times are right-wing papers.

[muriel_volestrangler]

78. Yes, except the Mirror

that's left wing - though still rather unreliable. But the Express, and especially the Mail (quoted far too often here on DU) are right wing - worse than The Times, and, in some ways, than the Telegraph (the Telegraph has a little more respect for fact).

[Lydia Leftcoast]

85. Back during the fuss about the Clinton health care proposal

the Portland, Oregon paper ran a "horror story" article about the NHS. A man of my acquaintance had lived in the UK for nine years as a company transfer said that he'd never heard of anything like the conditions presented in the article, and furthermore, that the article in question was copied from The Sun, which is a sleazy tabloid with low credibility.

Thanks for the correction about The Mirror. I looked through copies of the Daily Mail and the Telegraph that I found lying around on trains and buses, so I know what their slant is. I assumed that the mirror was the same type of thing.

[LeftishBrit]

89. Yes, and you've omitted the worst of all..

The Daily Mail and the Daily Express!

Actually the Daily Mirror is to the left of the others you mention; but it's an unreliable tabloid.

[Lydia Leftcoast]

112. Sorry, I was just mentioning the ones I'd seen lying around on trains and buses

:-)

[I work for workers]

67. This is a common problem. In general

national health care systems excel at providing equitable levels of basic treatment, but fall short of market based systems when it comes time for expensive high level care. The reverse is true for market drives health care.

I went to a conference on framing the health care debate a few months ago. The big thing: America needs an AMERICAN system, combining the best parts of our current system with new structures to increase availability and decrease costs. Of course that all comes down to hollow buzz words, but the sentiment is dead on.

[MilesColtrane]

69. What the fuck is a "social" abortion

Do these bastards think women in the country get together and have Abortion Bees?

And even if they did, what the fuck is it to them?

[muriel_volestrangler]

80. I would expect they mean one done because of the wishes of the woman

as opposed to medical reasons (health of woman or what the baby's health would be).

"what the fuck is it to them" would be the cost of it, paid through public funds. I don't agree with them - I think abortion should be available to everyone without payment - but that's what those people in the article are objecting to ("one in five said taxpayers should not pay for "social abortions" and fertility treatment").

[MilesColtrane]

83. Yes...

Funny that we don't hear any of their outrage over "social vasectomies".

After all, why should taxpayers have pay for the old snip snip when couples could just as easily pop down to the chemists for some Trojans?

(sheesh)

[lumberjack_jeff]

71. How barbaric! In our more enlightened country WE ration in a much fairer way.

We ration care on ability to pay.

The wealthy elderly should get that liver that some poor kid would otherwise get.

:sarcasm:

[depakid]

72. From the Telegraph, eh?

Think I'll wait to comment until I see a credible source....

[xchrom]

76. i don't like the telegraph -- which is a right wing rag -- but this has

been in the news before -- mostly regarding individual cases.

and it is a problem when you are talking about covering everyone.

i outside of right wing talking points -- i'd like to see how these supposed doctors feel about those who are say 30, 40, 50, or slightly older and have chronic conditions -- expensive ones -- but who go to work and contribute to society.

and lastly -- i think this butts up against schooling questions -- and how hard we push our children -- are we all just workers -- labour?
aren't we just by the mere fact that we exist -- something more?

i don't know.

[FunkyLeprechaun]

81. It may seem cruel

The idea is the fact that people here could quit smoking (the ban started in July) and get off their butts and exercise (I'm trying to do a routine, it is tricky in fact). The NHS, although it's beneficial to the population, is of limited resources. The smokers and the obese take up most of the resources while people like me (Cochlear Implants, which are very expensive for the NHS) need these resources.

Also, there's plenty of advertisements here for smoking cessation classes and smoking cessation aids. I do agree that it is incredibly difficult to quit smoking (I've got an oral fixation too, I have a habit of biting my nails and it's incredibly hard for me to stop).

Same goes for the obese, it's probably very hard to diet and trying to find the time to exercise. I have the perfect tv show for them... "You Are What You Eat". There's one part of the show that is absolutely disgusting... I have found myself eating better after each showing because of this one part of the show.

Then on the other hand I do find it cruel but NHS resources are very limited. Smokers and the obese COULD better their lives by quitting smoking and diet/exercise but they don't do that.

[NorthernSpy]

104. why should fat people and smokers be forced to pay for your cochlear implants?

They didn't cause your disability, and they don't get any personal benefit from treating it.

You seem to be demanding a kind of one-sided solidarity in which certain stigmatized groups of people have to pay for healthcare that they won't get to use.


If these "undeserving" people won't get equal treatment in your healthcare system, then give them back their tax money so that they can purchase treatment for themselves.

[FunkyLeprechaun]

114. Sorry

I didn't mean to make it sound like that. They should be treated under the NHS that's for sure.

I do wish they'd quit smoking though. I've got too many friends who do smoke. One of my friends who smokes (even has the distinct smoker's cough) had a check-up from his doctor and his doctor told him he was "healthy". I wonder how often that happens though.

[MilesColtrane]

84. Following this logic,

...why should they treat a rock climber with a broken leg?

After all, he brought that injury upon himself by risky behavior.

Why treat someone with an STD?

Again, that could have been avoided.

What crap.

[LeftishBrit]

88. That isn't in fact the logic

The logic of these doctors is not that one should not treat people with self-inflicted illnesses, but that one should not treat people with lifestyles that would make the prognosis poor even with treatment.

While all doctors have to consider prognosis when deciding on a treatment, it's dangerous IMO when costs are included in such an equation. Fortunately, this is the view just of a minority of doctors here; it is NOT the policy of the government or supported by the British Medical Association.

The Daily Telegraph are a very right-wing newspaper (generally known as the 'Torygraph') who are spinning this story in a misleading way, probably because of their own suspicion of the NHS.

[MilesColtrane]

90. That rock climbing guy is just going to go back at it when his leg heals...

...so why set and straighten that leg when he has a higher chance of injuring himself again?

If fact if he were hobbled you can be almost damned sure that he'd taken on his last cliff.

[LeftishBrit]

95. The point is not to stop people from smoking/rock climbing/getting old...

but to restrict funding to those who are likely to survive/recover in the short term. Thus, if there was evidence that a rock climber was less likely to survive someone setting his leg, then it might be taken into account (not the case, obviously).

I strongly disagree with the suggested policy, but it's based on 'health economics', not on someone wanting to be the lifestyle-police.

In any case, this is not government policy, but the recommendation of a minority of probably very right-wing doctors.

It is not likely to be put into practice, though other cost-cutting measures may (e.g. discouraging prescription of expensive but effective drugs), especially if we get an even more right-wing government.

[NorthernSpy]

108. fat people are more likely to survive a heart attack...

Actually, they're more likely than those of lower BMI to survive many kinds of health crises. All-cause mortality is lowest for the so-called "overweight" group (BMI above 25 and below 30).

If the rationale for this proposal were what you say it is, you'd think they'd take that into account. The overweight may in fact derive a greater benefit from treatment, in terms of remaining years of life, than their leaner peers.

[Thirtieschild]

86. I don't feel old, although most of you would probably think I am

I'll be 73 Saturday, my mother is 99, my father died at 90. The last 15 months of his life my father wore a colostomy bag, was dying of lymphoma, radiation had destroyed his saliva glands and therefore his sense of taste. His mind was as sharp as ever but life was painful, messy and difficult. Did I think he should continue chemo? Did he? No. He wasn't going to get well and, at 90, the side effects weren't worth it.

My mother had 12 inches of colon removed when she was 93 and has had a full life since then. At 99 she's slowing down but she still loves her games (bridge and a domino game called 42 that is popular in Texas), faithfully follows the Rangers, writes bad poetry, works the crossword every day. She can't hear diddly, hated her hearing aid and has now lost it, needs a wheel chair because her legs will give out on her, still lives alone in a retirement home but would be in assisted living if she could afford it. BTW, she didn't like Bush as governor and can't stand him as president. My sister, who lives in the same town as Mother, says she doesn't want to live to be 99, it's not worth the pain. After seeing Mother Thanksgiving my feeling was that her mind is still there but her life force is ebbing. Should she be given life-saving surgery now? No, not at 99. Should she have gotten it at 93? Given how rich her life has been since then, yes.

My conclusion? There isn't one answer that covers everything for everyone. How do we decide? I haven't a clue.

[jody]

87. Facts: U.S. health care costs $2 trillion/yr and rising, significant cost in last year of life,

boomers will hit 85 by 2030.

IMO society will not be able to fund the type of health care we would like and fund all the other social programs we want.

As an individual we view the problem one way but, society must make trade offs.

Like other posters, my personal experiences cloud my judgment having lost my wife of 47 years while she waited for a kidney transplant and myself having a heart arrest followed by open heart surgery.

On the one hand, I would give everything I have and will every have to have given my wife just one more day.

On the other hand, I wonder whether my open heart surgery is a better investment for society through my insurance programs than better health care for several children.

ANSWER: I don't have an answer but IMO society will soon be able to do anything in health care but not everything.

[Lars39]

93. Not at the prices in the US.

We've been charged what the market will bear. Other industrialized countries don't have some of the ridiculous prices for tests and procedures that we do.

I hope you're on an anti-depressant...most heart patients are.

[jody]

110. Not on anti-depressants. I take one prescription drug as a precaution against high cholesterol even

though all values are well within the desired range and I've never had a problem even without medication.

I would not be surprised however if some DUers need anti-depressants. :shrug:

You say "charged what the market will bear" but I wonder how many DUers would refuse a wage or salary increase if because their particular skill was in short supply?

I also wonder how many DUers protest because a few athletes or entertainers receive fantastical salaries just because their particular skill are in short supply.

[Oak2004]

94. Taking profit out of the system would be a good start n/t

[jody]

109. OK, but why not take profits out of all economic activities? n/t

[iamthebandfanman]

92. i know alot of doctors who still smoke

does that mean no treatment for them too ?

[aint_no_life_nowhere]

96. Yeah, turn these patients into Soylent Green

It's a far more cost efficient solution for the State.

[iamthebandfanman]

106. its made of peeeeopple!

nooo!

[NuttyFluffers]

98. only the healthy deserve healthcare. the sick deserve death!

:crazy:

i think someone needs to be fired ASAP

[NorthernSpy]

103. Anyone who won't be treated shouldn't be taxed either.

If smokers, boozers, oldsters, and fatties can't have treatment when they need it, why should they be forced to pay the bills of the Lifestyle Correct?


Speaking of which, what about someone who gets hurt while swimming or biking -- or in the course of some other inherently risky "healthy" activity? Haven't they "brought it on themselves" too?

[LeftishBrit]

116. Just to clarify a few things:

(1) This is not official British policy

(2) It is not supported by a majority of doctors

(3) There are a few doctors, greatly outnumbered by the rest, who have expressed support for such a policy

(4) This is being gleefully spun by the Daily Torygraph, who would like to undermine and bad-mouth the NHS in every way possible

(5) In any case, it is NOT a question of witholding treatment from those who are seen as having 'brought their illnesses on themselves' in favour of the 'Lifestyle Correct' (after all, the old may well have brought their long lives on themselves by being 'lifestyle correct'!) It's a question of rationing public health spending by excluding people who are in such poor general health that they are seen as unlikely to profit from treatment. While doctors will always take prognosis into account when determining treatment, there are big dangers in allowing cost to play a significant role in this. Therefore I am glad this is not a government policy!

(6) The dangers of rationing health care are more on other lines at the moment: i.e. sometimes a reluctance to prescribe medicines and other treatments that may be the most effective but are more expensive. We do have to fight to preserve the NHS from the cost-cutters and from domination by professional managers with no medical knowledge or experience. And you have to fight to *get* universal healthcare - and don't let the disinformation spread by the likes of the 'Torygraph' influence you against it!