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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?

To: Cogito who wrote (105967)	3/11/2009 5:31:07 PM
From: Lane3	Read Replies (2) \| Respond to of 541851

I would say the the stories we hear about negative outcomes due to rationing of care in England or Canada represent a very small percentage, too. Probably, but those are still only two among myriad factors, and certainly not a binary trade-off. Like I said, you don't have to up-end everything to fix your factor. Incidents resulting from rationing, OTOH, are potentially universal, not just affecting a small and easily identifiable portion of the population--those who have lost insurance just when some major illness occurs. The rationing victims are a more difficult target. There are a lot of concerns I have about a nationalized system, cost accelerated by moral hazard being the primary one, but here is an example of a standardization type of issue having to do with coronary artery disease, something you may not have thought much about lately being understandably preoccupied with the big C. I'd be interested in your thoughts. I believe the most advanced thinking on CAD is that the old Framingham risk factors are crap and that it makes the most sense to measure the amount of calcium actually in your arteries to see what your risk is of heart attack rather than LDL and other poor proxies for risk. You can get a heart scan that produces a calcium score of just how much plaque is actually in your arteries. This approach is not yet mainstream. As is typical of not-yet-mainstream screenings, insurance may or may not cover it. Medicare doesn't so I'm sure Medicaid doesn't, either. An article about how they are trying to get a law passed in Texas to require insurance companies operating there to cover it was posted on the Heart Attack thread. Meanwhile, you can have it done on your own dime, actually a few thousand dimes. It will be a while before resistance is overcome and the screening makes its way into the mainstream and Medicare and insurance policies cover it. Message 25483111 How might this play out differently in a nationalized system? It seems to me that change would be even slower. Now at least you can get a few states to try something and that serves as a test bed. You can also get a few entrepreneurs and advocates to set up test beds. After a dozen years of good results, you might have a chance of getting a critical mass of support behind it. With a nationalized system, who would be motivated to come up with a new approach? And where would you get the data to persuade the system to cover it if everyone was under a system that didn't already cover it? How much longer would it take a centralized system to make the decision to proceed with it and how much of that decision would be political? And how much would it cost if all of a sudden everyone were eligible for a new pricey screening? Would that affect the decision? And how many people would die from avoidable heart attacks while this was going on? I'm not seeing how this could be a good thing. You know, right now most medical care both under US insurance and in the Canadian system is that you go for an annual check-up, they take some blood, the results go to the doctor who scans the report for any asterisks indicating that some score is outside the reference range, which is as outdated and simplistic as minimum daily requirements for vitamins. They also do a couple of screenings like mammograms and EKGs. (Colonoscopies, which I believe to be effective were not covered until fairly recently.) The doctor says your results were fine--see you next year. That's it until you develop some symptoms at which time treatment is delivered and your life may or may not be saved. This is what passes for quality care. And the ardent hope of those who want a national system is that we all get that same care. Admittedly this is an improvement for those without insurance or independent means. And it does eliminate the stress of medical bills for those marginally insured. Many/most Canadians love their perfunctory and financially stress-free system. No one goes without a perfunctory level of medical care. In the process, we lose much opportunity for excellent medical care. The only alternative from there is a two tiered system, anathema to the egalitarians. We can make perfunctory care available to those who now don't have it by targeting them specifically. Then we can see where to go from there at our leisure.