Obamacare cost...

[Topper]

There was a report a few years ago about Michael DeBakey, one of the pioneers of cardiac surgery. One of the operations he innovated was for treating aortic aneurysms. In reviewing his outcomes it became evident that patients over a certain age didn't do well after the surgery and therefore the recommendation was that these patients shouldn't undergo the surgery - too expensive and resource intensive with unpredictable benefit.

Ironically, at the age of 90, Dr DeBakey was diagnosed with an aortic aneurysm. The size of the aneurysm would normally indicate surgery but his age would indicate no intervention. He knew the data better than anybody but still chose surgery. Even with the best info available it is hard to prospectively say who gets what treatment.

We always want to live. I remember my 88 year old grandmother, telling me, "Topper, I know I should feel otherwise, but I want to live just as much as I did when I was 18. I am not looking at moving on."

The existential question for an individual may not be the best answer for a society.

[cowboy]

The problem is that to reduce health care spending at the end of life you have to define "end of life" spending prospectively, not just retrospectively.

I know dozens of patients who I felt at the time were almost certainly getting expensive "end of life" care and here they are doing great 5+ years later, beating the odds by making a full recovery.

And pessimistic withholding of care becomes a self-fulfilling prophecy -- that makes me uncomfortable because a small but measurable number of people can make a full recovery from cardiac arrest, for example, but if care is withheld because the odds are unfavorable then nobody will survive.

There is so much uncertainty in medicine, every case is different. I'm totally in favor of aggressive hospice care and not doing expensive, futile surgeries but these are much more difficult to define prospectively than retrospectively.

I think the best way to handle this is make super expensive or low probability procedures an add-on to a standard policy. They would be rated similar to life insurance, based on age and dollar amount. Some could even be structured like a whole life policy that keeps premiums the same regardless of age or health.

[Katy Lied]

Wouldnt Palin call those death panels?

[Jarid in Cedar]

Wouldnt Palin call those death panels?

I want to sit on those panels. If real progress is to be made at controlling medical costs in the US, the death panels are going to have to exist.

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[Jeff Lebowski]

I have 3 boys and two girls. The girls have no say in whether to pull the plug on me or not.

Yikes. That seems awfully sexist.

[byu71]

Yikes. That seems awfully sexist.

Thanks. Appreciate your opinion I will let the girls know what you think

[Jeff Lebowski]

Thanks. Appreciate your opinion I will let the girls know what you think

Please share how the conversation goes. I would love to hear how you explain it to them.

"Sorry, but everyone knows that women aren't capable of making rational decisions."

[Topper]

Please share how the conversation goes. I would love to hear how you explain it to them.

"Sorry, but everyone knows that women aren't capable of making rational decisions."

No he was afraid the girls would pull the plug too early, but the boys want to keep him earning money a bit longer.

[Uncle Ted]

Bernie Sanders gets it... or isn't owned by pharmaceutical companies:

Americans shouldn’t pay more for drugs than Canadians, says Bernie Sanders

Bernie Sanders has clearly had it with American pharmaceutical companies gouging customers, and on Sunday he brought Canada into the debate.


In a tweet sent out Sunday morning, Sanders continued his attack on big pharma in a style that has endeared the 75 year-old Vermont Senator to millions.


“Americans shouldn’t pay higher prices than Canadians for the same drugs simply because Congress is bought by the pharmaceutical industry,” said Sanders.


Included with the tweet was a chart listing the various prices paid for drugs in the United States compared to their Canadian prices. The chart says Canadians pay $290 for an Epipen versus the U.S. price of $620, and $160 for cholesterol drug Crestor against $730 for the drug south of the border, for example.
[...]

[...]
Under Sanders plan, U.S. citizens would be able to import prescription drugs from Canada, but many aren’t waiting for that permission. Earlier this year, the Canadian International Pharmacy Association reported that dozens of the pharmacies it represents had seen an uptick in mail orders from the United States.

http://www.cantechletter.com/2016/10...ernie-sanders/

Yes, why wait for the government to allow the import prescription drugs from outside of the US?... Just follow the silk road.

[byu71]

Maybe a government insurance system wouldn't be so bad.

An associate here was telling me about a person he baptized in England about 30 years ago and has kept in contact with.

I guess the poor fellow has cancer that has progressed quite a ways. Whoever over there who determines these things gives him only a 30% chance of recovery if he gets chemo. Therefor they (the government) won't pay for it. That kind of policy could save a lot of money in health care costs.

[Topper]

Maybe a government insurance system wouldn't be so bad.

An associate here was telling me about a person he baptized in England about 30 years ago and has kept in contact with.

I guess the poor fellow has cancer that has progressed quite a ways. Whoever over there who determines these things gives him only a 30% chance of recovery if he gets chemo. Therefor they (the government) won't pay for it. That kind of policy could save a lot of money in health care costs.

The ACA didn't deliver what it said it was designed to do. http://www.forbes.com/sites/scottgot.../#62baee55777f


The Goldman Sachs report, which is far more inclusive than the Rand Study relied upon by the government shows only about 2 million more were covered despite all the costs and headaches. On top of that it is falling apart and the costs cannot be contained.

[byu71]

I was talking to someone who teaches entrepreneurship about how I thought new regulations and taxes will really hurt small business start ups.

He agreed, but said in his opinion Obamacare will be much more of an obstacle. While these young guys in start up situations are trying to make it, their insurance premiums will be a huge cash flow drain.

[beefytee]

There's little doubt that Universal health care offers the most opportunities to entrepreneurs. It is one less thing people need to worry about going out on their own.

[byu71]

There's little doubt that Universal health care offers the most opportunities to entrepreneurs. It is one less thing people need to worry about going out on their own.

I don't understand universal health care.

What is the difference between it and Obamacare?

Does everyone pay the same premium and the difference that saves money is the ability of the government to refuse treatment?

[Katy Lied]

Beefy Tee would have been shot for saying this just 5 years ago.

So Obamacare IS really working.