We already have the government involved. I don't see how that can be stopped. We may escape Obamacare but we will continue to have Medicare and Medicaid.
I realize that too. At least we can stop a total takeover and preserve the 40-50% of our system which isn't government controlled.
You didn't answer my question, which was "are you just opposed to the whole notion that in a pooled funding environment decisions are made that the pool won't shell out $20K for an extra week of life?"
I will question whether thats the case, except when patients, doctors and families voluntarily agree to limit treatment as futile near apparent death. It certainly wasn't the case for Obama's grandmother because she got a hip operation and died two weeks later.
As I pointed out, we don't have clocks on us and so the folks who run any "pooled funding environment" can't reliably guage exactly how long someone has left.
I infer from your response, then, that you think that pooled payment systems should pay for whatever the doctor orders/bills.
Obama's grandmothers case suggests that is happening now. I know my cousin received expensive cancer treatment shortly before he died of pancreatic cancer a year + ago. No one said the outlook for pancreatic cancer is so bad we just won't bother to try.
Which means that there would be no controls on cost effectiveness.
Does it mean that? I think families, individuals and doctors make decisions not to pursue futile courses of action all the time.
Are you sure that's what you want? If he orders taxol for a cold, the insurance company or Medicare should pay?
Please lets not dream up extreme situations. No one is ordering taxol for a cold.
If he orders a hip replacement for someone circling the drain, Obamacare should pay? Really?
I would assume a doctor, patient and family would only order a hip replacement when they believe there is hope it would be worthwhile. I don't think anyone would go through an operation when they know or believe it would be a futile action. I think Obama's grandmother and he and presumably her doctors had hopes for her eventual recovery when she had her operation. I don't think anyone could have predicted that she'd die two weeks later. No, I don't think Obama's grandmother should have been denied a hip replacement if she, her doctors and her family thought she had hopes of recovery.
Or is it just bioethicist input your object to and economist input is welcome?
Neither "bioethicists" or economists should be involved in making health care decisions for people. Patients, families, and doctors should do that.
If you have "bioethicists" or economists, the only thing they'll be able to do is set down broad rules .... like no hip operations for anyone over XX. Because they can't make decisions for individual cases, they'll have to make decisions for broad classes of people.
And btw, I don't believe insurance companies are enforcing those sorts of rules ie. no hip operations for folks over XX now. The argument that rationing (which will always have to be based on broad rules of the sort I just used as an example - couldn't be done otherwise) by government is okay cause its being done now by insurance companies is imo not true. |
