Ezekiel Emanuel, one of President Obama’s premier health care advisers–and the brother of his chief of staff–insists that rationing based on age isn’t invidious discrimination. Oh no? Check out this story from Sweden that illustrates how wrong he is. From the story:
An 83-year-old woman from Östergötland in southern Sweden was forced to pay for back surgery out of her own pocket after doctors at her local public hospital told her she was too old for the treatment. “Without the operation, I might have lived another five years in incredible pain. But what kind of life is that?” Marianne Skogh told the Östgöta Correspondenten newspaper.
Skogh has suffered from pain and numbness in her legs since 2004. After waiting for more than a year to see a specialist in the public health system [my emphasis], Skogh was finally told that the pain was likely to do problems in her back. Doctors told her she suffered from spinal stenosis, a disease that involves a narrowing of one or more areas in the back. The narrowing puts pressure on the spinal cord or on the nerves that branch out from the compressed areas, often causing cramping, pain or numbness. But despite the lengthy wait for the diagnosis, Skogh was then told that, even though the ailment was treatable [my emphasis, again], she was too old for the surgery.
It wasn’t that she was too frail to handle the surgery–obviously–it was because they thought she was too old to be worth the expended resources. In other words, she was denied optimal care by her own doctor who placed his or her loyalty to “society” over the medical needs of his own patients.
If this is how you think we should treat our senior citizens who have given their country so much over so many years–not to mention people with serious disabilities, expensive chronic and terminal illnesses, etc.–you will support Obamacare. If not, you won’t.
July 24th, 2009 | 9:57 pm
I love how black and white your able to paint the world. You either support the right of benevolent, beautiful, selfless, altruistic insurance companies to profit off of health care (with 50 million uninsured) or you want old women to DIE! So take your pick America, give money to the rich or grandma gets it!
July 25th, 2009 | 12:12 am
Mike: Except that is exactly what Obama has said–give them pain pills–and what his closest health care advisers recommend. You can bury your head in the sand if you want, but I choose clarity.
July 25th, 2009 | 12:56 am
You either support the right of … insurance companies to profit … or you want old women to DIE!
But of course, the profit of an insurance company is in itself a good thing. Nor is this changed because something basically not good (people uninsured) or basically bad (poor health) happens at the same time. You’ve got to make the extra step of showing that people are in poor health because insurance companies make profits. Otherwise, the choice you set up is as silly as saying, “either let doctors practice medicine or grandma gets it.”
it was because they thought she was too old to be worth the expended resources.
In fairness, the funding was probably withheld because she belongs to a class of people for whom this procedure is not deemed worth the expended resources. That judgment made by the state may very well have been made in part because people of a certain age are generally too frail to have a reasonable expectation of this procedure being successful (presuming it was safe). The problem may not be a lack of respect for the elderly but simply an inability to deal with the myriad particularities of individuals. I admit that this is giving the state a big benefit of the doubt on this policy. And it hardly helps the case for socialized medicine. But still …
July 25th, 2009 | 1:29 am
SMatthewStolte: See, here’s my thing. Doctors, of all people, should treat their patients as individuals, not members of a class to be valued highly or less highly, as the case may be.
July 25th, 2009 | 9:59 am
If it were your grandmother who was in such pain, would you want her to be treated? I sure would. Why are insurance companies always painted as demons? I would like to see medical savings accounts with all money spent for medical care, prescription drugs, etc. tax deductible. Another option would be catastrophic insurance which would have a large deductible and would be very appealing to young singles. There are a lot of ways to fix the system — socialized medicine isn’t one of them. Investor’s Business Daily has a great series on Obama care. For a summary check out: http://lesfemmes-thetruth.blogspot.com/2009/07/separate-facts-from-myths-and-lies-on.html
July 25th, 2009 | 11:16 am
Now, how accurate this is, I don’t know, but I’m reading indications that Obama’s administration stressing over the cop-vs.-the-prof. issue he opened his mouth about (which we shall not get into here), and the reporters in *those* stories are saying that this is coming at a bad time because, and here’s the quote:
‘The blowup had dominated national attention just as Obama was trying to marshal public pressure to get Congress to push through health care overhaul legislation — and as polls showed growing doubts about his performance.’
Source: http://news.aol.com/article/obama-calls-officer-who-arrested-scholar/579147?icid=main|htmlws-main|dl1|link5|http%3A%2F%2Fnews.aol.com%2Farticle%2Fobama-calls-officer-who-arrested-scholar%2F579147
…yeah, well, it’s a big honkin’ link…
Anyway, this is the sort of thing I’ve been reading ever since the whole open-mouth-insert-foot issue, suggesting that people aren’t going to support his health care overhaul in the long run because they’re irked with him in general. Dunno… hope they don’t.
July 25th, 2009 | 11:20 am
How exactly is profit a good thing? Is it a good thing when individual executives get billion dollar severance packages, at the same time the company is denying a liver transplant for a 17 year old girl? Why not go back to private fire departments, that was fun in the 19th century. America spends over $7000 per capita on health care (nearly 20% of the GDP), and that still doesn’t cover 50 million Americans! Sweden spends $2,800 per capita and covers ALL citizens. Why are single payer systems far cheaper and more efficient? Because they don’t have to turn a profit (done in America by excluding the poor) and they don’t have to have a massive bureaucratic corporate structure insuring that only those who are insured receive service, and the rest are excluded (20% of health care spending in America is on the overhead bureaucracy, 3% in Canada). Every time someone wants treatment in America a doctor has to file massive amounts of paper work to ask permission from the insurance company. 50% of all bankruptcies in America are caused by health care costs, 0% in Sweden. The insurance company can’t take your house in Sweden if you can’t pay.
“Doctors, of all people, should treat their patients as individuals, not members of a class to be valued highly or less highly, as the case may be.”
I really had to laugh at this one, in America its called the class with money. Its too bad that woman wasn’t broke and in America, we would have given her first class treatment like we give all are penniless elderly.
“They Dump the Sick to Satisfy Investors” Former CIGNA executive. http://www.democracynow.org/2009/7/16/former_insurance_exec_wendell_porter
July 25th, 2009 | 11:21 am
“profit” is not a dirty word. It is the reason, economically, that almost anything happens. Nor is the government without a kind of profit — they just print money and exploit people through power. That is “profit” too.
The point is that people should be able to decide what care they want and need and if this is denied then one can hardly call the process “free” in any sense of the word.
It’s always interesting to me how “choice” is important when you want to kill babies, but not important when you want to kill old people through neglect … hmmm… something common there right?
July 25th, 2009 | 12:00 pm
Profit in health care is why we get new, innovative drugs, why some wonderful hospitals are built, why biotech companies are pursuing stem cell research, etc. But many of America’s health insurance companies are non profit, e.g. Blue Shield, Kaiser Permanente, etc.
I would also note that when Barbara Wagner wanted chemotherapy to extend her life when her lung cancer returned, the health care rationers at Oregon’s Medicaid said no, but offered to pay for her assisted suicide. She eventually got the drugs for free–from the evil drug company, that offered her the care gratis when executives heard of her plight.
July 25th, 2009 | 12:14 pm
“Profit in health care is why we get new, innovative drugs, why some wonderful hospitals are built, why biotech companies are pursuing stem cell research”
Ya, and who pays for the decades of R&D at the university level? The tax payer, and only once the hard work has been done with our money does pharma come in and exploit the work done to develop a treatment. Drug companies are a great example of a publicly subsidized for profit industry.
July 25th, 2009 | 4:53 pm
I think the insurance companies should be shut down, which would allow the entire economy to rebalance and free up a lot of money for ACTUAL health care. Obama, the government, insurance companies — none of them have any business butting into anything to do with medicine. What happened to this elderly lady in Sweden is ALREADY happening here. Obama is a stooge and a president on training wheels who has never had an original idea; he’s parroting the worst of what’s already going on, and people are so wound up with the “health care” shibboleth that they can’t see the forest for the trees. Somebody just go and shut down the insurance companies, please, and then watch what happens: improvement.
July 25th, 2009 | 6:34 pm
Mike, again, profit is a good in itself and can only be called bad in relation to something else. So when you say,
Is it a good thing when individual executives get billion dollar severance packages, at the same time the company is denying a liver transplant for a 17 year old girl?
you are making some kind of non-sequitur. It isn’t enough that an intrinsically good thing occurs at the same time as a bad thing in order for the intrinsically good thing to be called bad. For instance, I may have the most delicious steak in the world on the same day that I have a deadly heart attack. Was eating the steak bad because I died shortly after? Certainly not. But if we add that the delicious steak were poisoned and caused the heart attack, then we can say that eating the steak was bad.
Now, profit is also good relatively when placed in the framework of a free market economy because each exchange must be perceived by the actors to be mutually beneficial, and so on. That’s a separate point, and advocates of the market need to keep making it but it’s also important, I think, to combat the odd notion that profit is an intrinsic evil.
But my guess here is that you have in mind not primarily the logic of cause and effect (as in the poisoned steak) but of merit and demerit. In this case, we imagine that the situation is something like executives sitting ’round a table wondering if they should help Sally pay for a new liver or whether they ought to spend the money for a jolly good time on an African safari. And as they laugh at the idea of helping out Sally, any ordinary observer would feel outrage at their callousness. Such a cold heart is surely deserving of punishment rather than reward.
But three things are important on that point: (1) In the hypothetical, unless the executives already owed the girl money for the liver, their demerit springs from a terrible lack of charity rather than a lack of justice; (2) I don’t think this is at all a good characterization of real executives; (3) The logic of the market is not merit nor should it be. A doctor who hates all his patients but makes them well may be less deserving (in the grand scheme of things) than someone who loves his patients but makes them ill. As one goes to the doctor not to be loved but to be healed, however, what’s in the doctor’s heart is, at best, of secondary importance.
For more or less the same reasons, the example of companies taking advantage of prior research also fails to support your point. It may be possible to make an argument that the relationship between public universities and corporations needs to be changed in this or that way. But I see nothing remotely blameworthy in a company making use of scientific knowledge (or, as you say, exploiting scientific knowledge) which has been acquired.
July 25th, 2009 | 7:40 pm
Your clinging to free market fantasies. The United States has never been anything remotely close to a free market economy, nor does any developed country follow free market principles. The free market doesn’t work, only poor nations who have it forced upon them follow it. Every major US industry is state subsidized and protected and always has been, that’s a fact.
A talk on this subject by one of the few economists I respect, Ha-Joon Chang. He mops the floor with the garbage preached by the likes of Thomas Friedman.
Why the World Isn’t Flat
http://www.youtube.com/watch?v=T5-ojv5-b3U
July 25th, 2009 | 10:28 pm
This makes me sick. What do we do? No one in the news is covering this, and I feel like many of us are just screaming into the wind…
July 25th, 2009 | 11:49 pm
Mike: I’m hardly a “free marketer,” or a, I think you meant MILTON Friedman acolyte. Although I had dinner with him once. Nice guy.
Socialized medicine doesn’t work. A single payer system doesn’t work. The pure free market doesn’t work. We need a mixed system, perhaps govt. to cover catastrophic care and subsidize people buying insurance–as in the Medicare Prescription benefit, which I think is a good model. We need market incentives and competition to keep costs down and efficiency up, with a vigorous and transparent tort system (no confidential settlements) to keep the insurance companies honest. At least that’s how I look at it now.
July 26th, 2009 | 4:05 pm
Thomas Friedman is a neoliberal contributor for the New York Times who wrote “The World Is Flat”.
“Socialized medicine doesn’t work.” Does your local “socialized” fire department work? Does your local “socialized” police department work? How about the “socialized” military? Are any of these institutions perfect? Of course not, but is anyone proposing to privatize them (well some are)? Please write an article explaining the horrors of our single payer fire service, and tell us the benefits of the 19th century insurance based system that used to let houses burn to the ground. I’m fine with a mixed system for unnecessary procedures such as cosmetic surgery ect, but basic health care should be a right, not a commodity. America’s health care system is the most expensive and inefficient on the planet (according to WHO statistics), and it needs to change.
July 26th, 2009 | 4:40 pm
The woman in Sweden who was denied help by the government run healthcare helps to keep the costs down. If you deny treatments then costs are less. When I was on group insurance if I wanted to talk to claims I could talk to one individual and get info, now that I am on medicare you have to talk to different departments with the government for help ie. one for doctors , one for hospital, one for outpatient, and one for lab. Believe me it was a frustrating experience as I was on the phone for 3 hours trying to get help. They had denied my claim and I had to get my senator to help. In the end the hospital and dr’s. had to send in claim forms to the government 3 times. If we have everyone covered by the government we will have 2-3 times as many employees as the insurance companies do. Is that cost saving?
July 26th, 2009 | 5:46 pm
Wesley-I think that you’re right: A pure private insurance system doesn’t work and neither does socialized medicine. We should have a system that provides govnt. aid for long term/catastrophic care and then have some other system to subsidize prescriptions, physicals, and other more mundane procedures/medications.
July 26th, 2009 | 8:17 pm
Mike: Sorry, I thought from the quote you gave that you were criticizing Milton Friedman. Frankly, Tom Friedman isn’t worth the time of day, in my book. I funny thing: He’s a big global warming guy and tells us all to cut back on carbon. But he (of course) has a huge mansion.
That aside, the fire departments and the police departments are locally controlled and managed. A good example of what government health care is like are the Veteran’s hospitals where people are often treated very badly, budgets are cut, and dedicated workers do the best with what they have.
So, give me a mixed system over a government monopoly any day of the week.
July 26th, 2009 | 10:50 pm
“I’m fine with a mixed system for unnecessary procedures such as cosmetic surgery [etc], but basic health care should be a right, not a commodity.”
I think one of the major sources of disagreement, here, is on the idea of the necessary. (Obviously, there are other disagreements, but …) Defining “necessary” in anything but a very narrow way is extremely difficult to do, especially since we don’t always know whether a treatment will be effective. Any decision about what kind of medical treatment to receive must take into account multiple variables. How serious is the problem and what could possibly happen if I do nothing? Can I help alleviate the problem by changing my lifestyle (fewer work hours, more exercise, better diet)? Is such a lifestyle change an option for me? Are there various different drugs that I might be able to take, and what sorts of side effects might they cause? What sorts of side effects am I personally able to live with? How expensive are they? How many years have they been regularly prescribed (ie, do we know if they have long-term side effects)? How much does this treatment cost? And you could go on and on with these sorts of questions. For some of these questions, a National Health Service could set standards. But since the answers are frequently going to be in terms of probabilities rather than certainties, and since some people are more risk averse than others, determining necessity is going to involve some arbitrary decisions.
Some other questions to consider: Is Viagra a necessary drug? Is cosmetic surgery always unnecessary or might it be necessary in some circumstances? Do the answers to these questions not differ from person to person?
July 27th, 2009 | 11:42 am
I think insurance for everyday health care is the problem. We have become accustomed to having our health insurance pay for anything from a simple blood test to a band-aid in the ER. And now we think that if you don’t have health insurance to pay for that band-aid in the ER, you need the government to pay for it.
We need to go back to paying out of pocket for simple services like routine physicals and tests. This would lower costs in so many ways. Patients would ask how much things cost and shop around for the best deal. Doctors would respond by offering competitive prices. Patients would buy only the services they need instead of a battery of tests that their doctor ordered just to CYA so that they don’t get sued.
Health insurance is not insurance for your health, it is insurance against financial ruin if you get really sick. I think that medical savings accounts where patients directly pay for their care with a catastrophic policy for serious illness or injury is the answer. No big insurance company making millions, no rationing, and the patient gets to choose because they are the ones paying.
July 27th, 2009 | 2:49 pm
I’m left wondering about this notion of doctors ordering all kinds of unnecessary tests and procedures. In all my years, all I’ve ever heard were tales of woe from friends and family about having their chronic symptoms brushed off by quickly dismissive doctors. Years would go by until they found doctors who’d have tests done. The tests would reveal that yes, their pain had an actual cause. Treatments and procedures would at last be done for conditions that by then had unnecessarily progressed. If we’re wasting money on health care, it seems to me that we might save more by testing and treating early and often. That is, of course, just my personal anecdote, but it leaves me nervous about the proposed system.
July 27th, 2009 | 6:37 pm
it leaves me nervous about the proposed system.
Nill, do you mean Rebecca’s proposed system? I don’t think fewer check-ups would necessarily follow from her suggestion (unless the patient himself wanted fewer check-ups, but that doesn’t seem to be the difficulty in your anecdotes).
July 28th, 2009 | 5:41 pm
Ah, seems I wasn’t quite clear about which system(s). The concern was directed toward what the Obama administration has been talking about.
August 19th, 2009 | 11:36 pm
In my case, the VA doesn’t do one of the tests they nevertheless think I should have, and suggested I have a private physician do it.
They also bill my current insurance, so I’m paying for it, not the taxpayers.
And the drugs they charge me $8/mo for I can get for $4.50 from those evil capitalists at WalMart, or, for common antibiotics, FREE at Meijer’s.
Curse those greedy capitalists.
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