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On my recent visit in Vermont, at our HS reunion, one of my best friend's in HS and I were talking about end of life issues. Marshall said, "we treat our dogs much better than we do people" [at those end of life (EOL) times, when people are kept alive with little/no quality of life]. I whole-heartedly agreed.

A day or so later, I was talking with my niece's daughter (it's awkward to say great-niece but she is great) who has an MPH (Master's in Public Health) and works on health policy issues at a large, well known Boston hospital.

I shared with her what Marshall and I had talked about and mentioned Obama's push for health care reform.

She was very pessimistic that any meaningful reform can be accomplished because there are too many players involved (health insurance companies, medical specialties, nursing homes, hospitals, medical associations, pharmaceutical companies, pharmacies, etc., to name just a few) and too many politicians who are grateful for the support from those factions.

IIRC, she said health care is our (USA) nation's eight biggest industry (or was it the sixth?) and that in the US, one third of all health care dollars are spent on the last 6 months of a person's life (trying to delay or prevent the EOL). While most of those EOL people are elderly, that "last 6 months" was compiled from people of all ages.

One thing she thought might help is if a new medical specialty of physicians was developed to deal specifically with EOL issues (because most typical physicians try as hard as they can to delay death as long as posssible, using every possible intervention).

The USA spends by far the greatest amount per citizen of any nation yet we have the greatest per cent without health care and rank very far down in comparison with other developed nations in general quality of health care (infant mortality, infectious diseases, etc.). It's a system that works for those with adequate money but not for others.

Since paying for health care benefits/insurance has traditionally become the responsibility of USA employers, as health care costs have so sharply increased, they are at a competitive disadvantage selling their products in competition with mfrs from other countries which do not have those costs to be covered.

I hope, and she hopes, her pessimism is mistaken.

But I sure haven't got much idea of how to proceed. I DO think we need to reduce the amount of "take" all these players are getting.

For instance, many health insurance companies are for-profit corporations with stock holders who want maximum return on their shares. They pay executives, managers, sales, quality control, HR, examiners, etc., and their employees have health and retirement benefits.

These function as middle-men between the employer/employee and the health services providers.

To my mind, it's as if we were to employ a middle-man service compamy to buy our food. They'd set the price on what could be bought, what we could have or not have, what we'd have to pay extra for. They'd negoitiate with Aldi, Kroger, A&P, Hy-Vee, Trader Joe's, etc., for what they'd pay for which products. And then we'd have to take what they procured for us.

IMO, in the long run, we need to shrink these puppies. But they're currently such a large part of our economy that has to be done very gradually and in a way that lets those millions employed in the industry be absorbed by other work.

How?

Who knows.

Terrible, terribly complex American problem.

 

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You are so right that it is a very complex problem. I wish I had some solution, but I do not. I know when I lost my granny many years ago, she had had a stroke, and it had robbed her of the ability to do anything really, One look at her, and you could tell her days were numbered. While I do not think euthanasia is proper, even if it were legal, her wishes, and I completely agreed, was that no extraordinary means (life support, Harvey Team, stuff like that) were to be used. So we just kept her as comfortable as possible.

I know I do not want to be kept alive, if you can call it that, by artifical means. And I can believe that 1/3 of a person's medical expenses are spent in the last part of life, regardless of age. The solution? I have absolutely no idea. I do not think a Givernment Run anything is the answer though.
 

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I cannot BEGIN to tell you the misgivings and questions I have had since Tudor's death. I know, I know... you always look for someone to "blame" or lay responsibility upon. There are just some details that don't work for me and it claws at my brain and heart.

:(
 

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Doctors didn't want to treat my father when, at age 80, he developed fairly advanced prostate cancer. He had several other health issues and they simply wanted to manage his pain. He insisted on treatment. In the years between 80 and 85, when he passed away, he got to experience the marriages of three of his children and the birth of several grandchildren to whom he was absolutely devoted. He wouldn't have missed those years for anything.

My concern is that the government "managing" healthcare will mean that decisions like the one my father made will no longer be available. There simply won't be unlimited healthcare for everybody; there's no way to afford it. I don't want to see the elderly denied treatment because their longterm prognosis isn't good.

You can scoff at this and tell yourself it won't happen that way, but it's already happening in the U.K. and Canada.

And of course my standard objection to what is going on right now is this need by the administration to push through huge programs with little input, huge money commitments, and everything being called an emergency that has to be dealt with today so there's no time to waste and apparently not enough time for anybody to read the legislation. Huge decisions shouldn't be made this way.
 

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Had a similar experiance Robin, my Dad was in a coma for over a month after a heat attack in 1999, Drs said he could come out of it so we kept up treatment, he had 6 more years of a pretty decent life, got to see the Grandkids graduate, got to see his first Great-Grandchild and lots of other things. Yes we're glad we went as we did.
 

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GolfGirlRobin, regarding your comments about Canada's health care and the elderly, I think what you're hearing is US health care propaganda. Of course, all the insurance companies etc don't want to lose their gold mine, and they are fighting like crazy to keep what they have!

My uncle had knee replacement surgery at age 91, and is still going strong several years later. My MIL, at 86, has wonderful health care - regular physio appointments, home-care, and of course, periodic doctor appointments. All my elderly relatives get good (and, of course, free) health care, and I've never heard any hint that the aged would be poorly treated to save $.

Personally, having heard such horror stories about the US system, I would never, ever, want a for-profit health system determining my health options.
 

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I know that I don't want any extraordinary efforts to keep me alive--quality of life is important to me.
But
, I do believe that the decision should be between patient and doctor. NOT doctor and government. And I'm very afraid that is where we are headed.
I really don't want the government deciding when I should get treatment and when I shouldn't.
 

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GolfGirlRobin, regarding your comments about Canada's health care and the elderly, I think what you're hearing is US health care propaganda. Of course, all the insurance companies etc don't want to lose their gold mine, and they are fighting like crazy to keep what they have!

My uncle had knee replacement surgery at age 91, and is still going strong several years later. My MIL, at 86, has wonderful health care - regular physio appointments, home-care, and of course, periodic doctor appointments. All my elderly relatives get good (and, of course, free) health care, and I've never heard any hint that the aged would be poorly treated to save $.

Personally, having heard such horror stories about the US system, I would never, ever, want a for-profit health system determining my health options.
Actually I know someone in Canada that needed heart surgery. Couldn't get into the hospital and was put on a waiting list. The family was on pins and needles during that wait. Would their loved one make it or not? :eek: I don't know of any US hospital that would put someone needing heart surgery on a waiting list.
Hip replacement, yes. Heart surgery, no.
 

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I really have to stress this point ... my doctor does not call the "government" whenever he makes a decision. I'm truly puzzled by this notion.

It seems (from what I hear about the US system) that the insurance companies make a lot of decisions about health care -- wouldn't you want your doctor to be fully responsible for your health?
 

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Actually I know someone in Canada that needed heart surgery. Couldn't get into the hospital and was put on a waiting list. The family was on pins and needles during that wait. Would their loved one make it or not? :eek: I don't know of any US hospital that would put someone needing heart surgery on a waiting list.
Hip replacement, yes. Heart surgery, no.
My co-workers husband just had heart surgery, and yes, he got bumped for an emergency. It's triaging.

I'm curious, if someone has no insrance overage and no $, do they get heart surgery right away? (If yes, why would anyone bother with insurance?)
 

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I really have to stress this point ... my doctor does not call the "government" whenever he makes a decision. I'm truly puzzled by this notion.

It seems (from what I hear about the US system) that the insurance companies make a lot of decisions about health care -- wouldn't you want your doctor to be fully responsible for your health?
While your doctor may not "call" the government, does he not have parameters issued by the government?
My doctor doesn't call the insurance company every time he treats me. The only times the doctor's office will call the insurance company will be for hospital admittance or special (read expensive) testing.
 

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While your doctor may not "call" the government, does he not have parameters issued by the government?
I'm not aware of "parameters issued by the government". I can't think of a situation where a doctor would limit treatment based on a government directive, especially concerning the elderly (which the OP was about). With my FIL, all health options were taken - at the end, he died quietly & with family. There were no issues about what care to provide; only what was best for him. Several years ago, my husband had a mental health crisis - again, full medical care was given, no limit to dr appointments or any such thing.

Any Canadian nurses or doctors here on JL to join this discussion?
 

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I'm not aware of "parameters issued by the government". I can't think of a situation where a doctor would limit treatment based on a government directive, especially concerning the elderly (which the OP was about). With my FIL, all health options were taken - at the end, he died quietly & with family. There were no issues about what care to provide; only what was best for him. Several years ago, my husband had a mental health crisis - again, full medical care was given, no limit to dr appointments or any such thing.

Any Canadian nurses or doctors here on JL to join this discussion?
There may be a better way to look at this.
Let me ask you this: would you want the US government deciding what type of health care you can get?
 

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I know insurance companies have guidelines, I'm sure anything the government offered would have would too.

My Dr. can often fight with insurance guidelines, I doubt he'd have as much luck with the government.
 

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The owner of my company grew up in canada and now is a citizen here. He has family on both sides of the border, has had several relatives on both sides go through surgery and various other health issues and had his father die recently.

After experiencing both sides he says he want's all treatment for him to be done in the united states. He says it's not the quality.....IE the health care providers are equally talented.......it is the system that scares him. He mentioned that all you have to do is spend time in a hospital on both side for it to become clear.

Since I have only experienced one side I guess I couldn't say which is "better".
 

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Please everyone, do you really think government CAN manage healthcare. They can't manage anything. The country is in a shambles because of the dolts in Washington, all of them, democrats and republicans.

We do NOT need Government to control ANY part of our lives.

When are you going to wake up.
 

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Please everyone, do you really think government CAN manage healthcare. They can't manage anything. The country is in a shambles because of the dolts in Washington, all of them, democrats and republicans.

We do NOT need Government to control ANY part of our lives.

When are you going to wake up.
Oh I agree. 100%
 

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OK, haha, maybe I wouldn't want the US government handling it. Mind you, given the reputation of the private sector in the US, not sure I'd want them handling it either!

3TailsWaggin, it's sad that you feel that way. You really feel that the state of your country is all the government's fault?
 

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What is the difference between the Government saying no and the insurance company saying no? The insurance company is out to make a profit. Health care for a profit is just wrong in my opinion. At least everyone in Canada has healthcare. Sure there are some limitations like a physical once a year and various other test are only allowed once a year but if you have a problem and you need more test you get them.
 

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What people also need to remember is that Canada has no people. 36 million from what I've read. That is the population of California. Although I've heard a lot of horror stories about Canadians who come here for treatment, even if you do think it's a good system, you have to remember that we will end up with ten times more people involved in it. Ever seen anything that large run with any degree of efficiency?

I also think that if you're Canadian and you don't think your doctor has to justify the testing and treatment options he uses, you're crazy. You may not be involved in it, but a doctor who is outside the norm when it comes to numbers is going to be sitting in a meeting explaining why.
 
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