Baby death panels
Guest post by Jacqueline Halbig, principal at Sovereign Global Solutions and former senior policy adviser for the Dept. of Health and Human Services
If Obamacare is supposed to increase health care access and affordability, why does it seem to punish those most in need? Consider minority babies, both unborn and born.
Perhaps we shouldn’t be surprised that an administration which redefines abortion as health care continues to expand funding to Planned Parenthood, which operates the nation’s largest abortion chain.
Planned Parenthood is underwritten by taxpayer dollars to the tune of $480 million ($365 million from federal funds and the rest from state and local funds). Now, under Obamacare, Medicaid expansion will further fill its coffers.
This type of funding is even more disturbing given that Planned Parenthood appears to be targeting minority populations with its abortion “services.” A 2011 study called “Racial Targeting and Population Control” by Life Dynamics Incorporated revealed that Planned Parenthood clinics are 2-1/2 times more likely to be in neighborhoods with a disproportionately high Black and Hispanic population.
But it is equally troubling that if they survive life in the womb, these babies, especially those born prematurely, now face an even greater uphill battle – receiving needed health care.
Every year between November and March, there are outbreaks of Respiratory Syncytial Virus, an illness similar to the flu.
RSV is the leading cause of pneumonia and bronchiolitis, and hospitalization for children under the age of one; premature infants and children before the age of two with congenital heart or chronic lung disease are considered to be at highest risk.
Each year RSV causes two million hospitalizations and 14,000 deaths. In addition, RSV disproportionately affects minority and especially African American babies, who, according to the Centers for Disease Control, are 59% percent more likely to be born prematurely than white infants.
While there is no vaccine for RSV, there is an FDA-approved treatment available. When it became available in 1997, the American Academy of Pediatrics issued evidence-based guidelines for its use, recommending that the treatment be administered once per month during outbreak season (an average of five months total).
But in 2009, with no clear medical evidence for doing so, the AAP both shrunk the pool of eligible infants and reduced the number of RSV treatments that would be made available – for some babies down to 3 doses, while for others as low as 1 dose. The only clear reason given was cost.
Unfortunately, the AAP’s guidelines are widely implemented by Medicaid and insurance providers, who in turn followed suit and greatly reduced coverage.
In response, concerned groups of parents, prenatal advocates, and medical providers such as the National Perinatal Association, the National Medical Association, and the National Black Nurses Association have pointed out that there is no definitive research to support these changes (indeed, these are not FDA-approved doses) and are urging the AAP to reconsider their recommendations.
If cost is the issue, let’s consider the cost of non-treatment. A 2010 study by the NMA and NBNA showed the rate of hospitalization and emergency room visits without proper treatment for RSV is astronomical.
For example, a child not properly treated for RSV is five times more likely to be hospitalized and more than twice as likely to visit an emergency room visit than with the flu.
But for those premature infants who received treatment, hospitalization decreased by 55-80%. Furthermore, infants who received the recommended treatment had decreased emergency room and physician office visits. As a result, there are cost savings associated with proper treatment.
Since RSV disproportionately affects African American, Hispanic and premature babies, there is great concern that this rationing policy will further increase health disparities in these communities.
So what’s the real benefit of limiting this treatment? If Obamacare’s objective is to make health care more accessible and affordable, an honest cost benefit analysis would respect the bottom line and acknowledge that an ounce of RSV prevention is cheaper than a pound of emergency room cure – unless their bottom line equates death as the cheapest option.
To support the children and families affected by this rationing decision, please sign this petition at Change.org.

I don’t understand how the author is trying to tie this to health care reform? The AAP guidelines came out in 2009, a full year before reform even was passed.
I think the author might be trying to be cute in tying the two together, but it seems be dishonest.
In addition, RSV disproportionately affects minority and especially African American babies, who, according to theCenters for Disease Control, are 59% percent more likely to be born prematurely than white infants.
Whaaaaaa?! How can that be? You mean…abortion increases the risk of preterm birth? But NARAL and PP told us that’s not true!!! They LIED to us?! The horror!! I can’t believe that such peaceful, righteous organizations would LIE to us and tell us something untrue, even though all the most recent studies have proven the same thing that these numbers are telling us?
I think the author’s point is that the AAP is issuing guidelines based on political preference and not on scientific evidence. There is a genuine concern that this political approach will only get worse as O-Care is implemented. Already the AAP supports girls getting abortions without parental consent and recommends pediatricians prescribe the different morning after pills to pubescent girls without parental notivication or consent.
Tim – if that was the author’s intent – they did a horrible job making the point. Furthermore, you can find articles pretty readily in regards to the AAP and why they made the decision.
Anyway, I have more concern without health care reform in place. Under GOP plans, medicaid would be fully in the hands of states – and what do they typically do in times of financial trouble? They cut back in medicaid. This is a real strong case of right wingers complaining about something that their policies strongly suport.
Ex:
Obamacare exacerbates all of the problems in our health care system and is making health care ultimately an exercise in political manipulation. Very little good will come of Obamacare, and what good that actually comes from it will be far more expensive than envisioned by the proponents. Look at how rates are jumping in the double digit percentages already just to cover the real and anticipated costs of the “freebies” and mandated coverages. So much for the average family’s costs going down $2500/year as Obama said they would for the average family.
Jerry –
While I appreciate the feedback, it reads like a bumper sticker without any actual substance to it.
Certainly, everything will not be rosy and wonderful under the new system, as it certainly isn’t rosy and wonderful now. We have some large fundamental problems with how health care is delivered that nobody is willing to address as this point.
Regardless, while there are some crazy outlier numbers that biased think tanks are coming up with, the majority of information looks good in regards to the future of the system. Again, the world won’t be fixed overnight, and I still believe that a single payer system is inevitable – but for the majority of Americans, the system under health care reform will be better than we have had before it.
Ex:
As the main cheerleader for Obamacare on these pages I would expect nothing else from you. Your dialog with Mary on the issue over the past months appears to have fallen on deaf ears. I cannot do better than she did and will not try. She gave you very substantive arguments and you ignored them.
You pretend that the proof will be in the pudding at some future date after single payer comes along and that the present projections are “crazy”. You are looking at it through rose colored glasses, my friend. Admit it, there is nothing that can be said or done that will shake your faith in your hero Obama and his singular “achievement”.
I feel sorry for my peers who are now or will be soon going into Medicare and also for the next generations because they will know what they have lost. It is all political manipulation of healthcare from this point forward. If a person is in a favored constituency they might not have a problem, but if the rationing board decides they are too old or othewise deemed ineligible for certain procedures–tough luck!
It is no use arguing with Ex but the MDs know IPAB is going to make it worse, they know they are ”death panels” with no appeal process and that fighting with the federal govt. is useless. If you think healthcare is faulty now you ain’t seen nothing yet. And the good docs that can are leaving their practice to get out now while they can or if they continue to practice many will stop taking Medicare that really tells you a lot. It’s ok Ex, Dr. Ben Carson “doesn’t know what the hell he is talking about”, he’s just a brain surgeon who has saved probably thousands of babies lives from all over the world, cares about his patients and prays before every surgery. He says we can fix this mess we don’t have to dismantle and destroy the best healthcare system in the world to do it and that you don’t have to be a brain surgeon to fix it even though he is one. Naaaaah! He doesn’t know what he is talking about but BHO, Kathleen Sebelius, Nancy Pelosi, Celeste Richards and company now they are the ones who know, that is why they “had to pass the bill so you would get to find out what was in it.” Brilliant!!
Jerry -
I started to put together a long response to your post, but quite frankly, if you believe that a death panel exists in which individuals are decided if they are too old or not, or if certain procedures for certain individuals are warranted or not – if you actually believe that, it renders all your other opinions on health care to be irrelevant. It’s like walking into a room of people watching a football game and asking how many points Michael Jordan has scored.
Seriously – and I mean this in the nicest way – if you want to talk health care, I can point you to some policy blogs out there to better understand what exists and what is coming. But if your knowledge of the situation is this far lacking, it is going to do us no good.
Prolifer
- Dr. Ben Carson “doesn’t know what the hell he is talking about”
Finally, we agree on something. Thanks!
Ex-GOP, it’s cute the way you ignore that when someone says “death panel” it’s probably shorthand for the view that the Patient Centered Outcomes Research and economic metrics will result in coverages/treatments being denied. Given the current climate where a (large?) segment of the population has a lack of trust in the government and pharmaceutical companies coupled with exploding health care costs, it doesn’t make you look smarter than others to keep trying to shove that concern under the rug because you don’t like the term used to describe it. Although the ACA may not allow distinct thresholds to be set, please show me where it prohibits using cost effectiveness in decision-making and how that will be enforced.
Ex, just curious. Is there ANYTHING BHO does that you will not defend?
Hi PLL,
Any discussion of a man of Dr. Carson’s brilliance, accomplishments, and life story is enough to cause any liberal to foam at the mouth. Do not expect any kind of rational response…or behavior, when you mention Dr.Carson’s name to a liberal.
How can people say that our healthcare system is the best in the world? We pay more money for poorer outcomes than a lot of developed countries.
Then why do people come from all over the world (including Canada) to get care here? :/
Hi Jack,
Point taken, so let’s turn it over to the government which has only succeeded in creating a cumbersome monster that it has no clue how to implement or regulate.
http://obamacarewatcher.org/articles/172
Kathleen Sebelius has admitted implementing this whole Obamacare thing is more complicated than she thought.
You expect what else when the government takes over something?
Hi Jerry 11:17PM
Thank you for the acknowledgement and support. Another example of the efficiency and cost savings of Obamacare.
http://washingtonexaminer.com/tens-of-thousands-obamacare-navigators-to-be-hired/article/2526167
Hi PLL,
I should qualify my comment of 11:59am as any black man of Dr.Carson’s……
Nothing brings out the best in liberal enlightenment and tolerance like a black man or woman of Dr.Carson’s stature who doesn’t tow the liberal line.
Xalisae – because it’s easy, if you have the money to travel and pay high bills, to see a specialist as quick as you want in the US compared to other countries. Most people in those countries don’t have the option to travel and seek healthcare, you’re comparing a tiny group to the majority.
But what I said is true, we aren’t near the top for markers such as maternal mortality, infant mortality, life expectancy, etc etc etc. Calling us the “best healthcare system in the world” is a stretch. We have our good points, but so do other systems. And I don’t think that the fact that wealthy people from other countries come to see our specialists changes the fact that we have poorer outcomes overall.
And before anyone (Mary ;)) brings up Canadian hospitals contracting with US border hospitals to provide care, that’s less than one percent of Canadian patients, a very small amount of people receive care here. The rest of them use the Canadian system and their health outcomes overall are better than the US. Not that I think Canada has a perfect system but there are some parts that are superior to the US.
Well, personally I’d like to take my chances with taking the rest of my longer life to pay the high bills associated with cost of care than getting put on a waiting list to die. But that’s just my preference. At least here I have the option of even taking up a freakin’ collection to help with bills instead of being at the mercy of The State.
Jack,
I don’t care how many Canadians must use our health care system. If Canadian health care is so wonderful, why does the Canadian government need to contract with American hospitals at all? They sure shouldn’t need any help from us, don’t you agree?
Hi X,
Just watch how quickly prominent wealthy American liberals who support government run health care for the rest of us hightail it to Cuba or Venezuela for their health needs. More likely it will be a trip to the Mayo clinic.
Thousands of Americans die from lack of access to needed healthcare: http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917
Like I said, we generally have poorer outcomes in most markers. This isn’t a secret. In the US we have easy access to (far more expensive) emergency healthcare, but they do in most universal healthcare countries as well. We have a problem with people having access to preventative and maintenance care in the States, in universal healthcare countries there is a problem with long waits for treatments but in general you aren’t denied needed healthcare because of money to the extent that it happens with the US.
Mary please copy and paste where I said Canadian healthcare is “wonderful” or in all ways superior to the US? I believe I said that both systems have their good points and it’s not wrong to look at what other countries are doing and try to learn how to fix the issues we have.
Also, I don’t know where in the world you guys get your info, but many countries with public healthcare options also have options for private out-of-pocket pay or private insurance. In Australia, you pay more taxes if you choose to use the public health insurance, you get a tax break if you provide yourself with private insurance. I’m not sure what the tax deal is if you remain uninsured or if that’s legal, but it’s not like they are banned from getting their own insurance. I don’t like this alarmist black-and-white thinking. The options aren’t “private healthcare only or throwing yourself on the state and wasting away on a waiting list”. There are several different ways to set it up to insure those who can’t afford while providing those who CAN with other options if they wish to have a different standard of care. For goodness sake.
You guys do understand that wealthy people in the US travel to other countries for many different healthcare reasons too, right? It’s not just people from other countries coming here. Healthcare tourism happens both ways for whatever reasons.
Speaking of Cuba and medical tourism from the US, that already happens. Because of the embargo and travel restrictions and such US citizens generally travel to Canada or South America or whatever to get there unless they get government approval. There was an article in the Miami-Herald about it a while back that I read, Cuba sees an estimated 20,000 medical tourism patients. People from the US go there for lower prices and such.
Jack,
If this is you EGV, and it sounds suspiciouly like it is, I’m really not going to get dragged into any more discussions like these. No matter what I say it hasn’t registered yet and I seriously doubt it ever will.
I didn’t say you said the Canadian system is wonderful or in all ways superior to the US. Please copy and paste me directly quoting you.
If you’ve fallen hook, line, and sinker for Obamacare there is nothing I am going to do at this point to change it. If you want to remain oblivious to the lies of the Dear Leader be my guest.
BTW, do a little googling about Obama’s lies concerning Obamacare. I don’t care to do your research for you.
Also, health care “tourism” is a face lift at bargain prices with a luxury hotel or safari thrown in as part of the package. Its not a trip to Mayo to treat cancer.
I’m not Ex I am JackBorsch, I changed my name like I’ve been meaning to for like a year lol.
I don’t particularly like Obamacare nor do I like the system that we had/have before it’s implementation.
Healthcare tourism can be stuff like cosmetic surgery but often it’s not.
Well Jack,
Of course medical tourism is great for Cuba. It brings in desperately needed revenue. That proves what?
Hi Jack,
I stand corrected and my apologies to EGV.
I wasn’t saying it was “good for Cuba” that wasn’t the point of my post. The point is that you claimed that people would leave the US for care if we have publicly funded healthcare, my point is that it already happens.
Hi Jack,
Don’t mean to be abrupt, you know I like you, but I’ve gone over these arguments more times than I can count.
Furthermore, while the system isn’t perfect, government takeover, as you can see, has only generated more inefficiency, expense, and bureaucracy.
Hi Jack, 3:35PM
No I didn’t.
If you don’t want to discuss it that’s fine. I understand your viewpoint and agree with certain parts of it, I just don’t agree with some other parts.
I don’t get the point of your 2:18pm comment then, if it wasn’t how I understood it.
Speaking of Cuba again, their universal healthcare system is on par with developed nations (and their infant and maternal mortality, as well as life expectancy, is slightly better than the US) in regards to the healthcare system. That’s a communist country with an economy that’s basically strangled with the embargo and such, they have trouble getting meds and all that. Why do you think that they have decent outcomes for healthcare and have the highest doctor/patient ratio in the world? Do you think it speaks to some benefits to a universal healthcare system (obviously there are some drawbacks, but it’s not a completely awful thing)?
Before anyone calls me a commie I’m not defending their government and economic structure. I just find it interesting that they manage decent healthcare outcomes with the stress that the country is under from other factors, and you know that Cuban citizens generally can’t travel to receive healthcare elsewhere, so the healthcare tourism isn’t skewing the numbers.
The healthcare system is literally the only thing I haven’t heard the ex-pats down here complain about when they go on and on about Cuba.
Hi Jack,
I was making a point of the hypocrisy of the likes of American liberals like Michael Moore who sang the praises of Cuba’s health care system but admitted he would go to Mayo Clinic if given a choice. He could certainly well afford to go where he darn well pleases even though he looks in desperate need of a good barber, fitness trainer, and a gift certificate from K-Mart.
As to how good the health care system is may just be a matter of perspective.
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The only thing "free" ever means is someone else is footing the bill. What happens when the government, i.e. the taxpayer can't?
Call you a commie? Far from it my friend. BTW, medical tourism is just old fashioned capitalism. Offer a product at a great cost with added benefits, i.e. a luxury hotel, the best hospital facilities, pampering, etc. and you can heap great financial rewards.
One more thing Jack, if the Cuban health care system is so marvelous, why does Castro import Spanish doctors to tend his needs? Does the average Cuban citizen have the same option?
http://www.cnn.com/2006/WORLD/americas/12/24/castro.health/index.html
http://www.washingtonpost.com/wp-dyn/content/article/2007/01/16/AR2007011601325_pf.html
Hi Jack,
I have to repost the first link concerning matter of perspective. My computer went black on me again and when it does that its usually a sign of demonic possession of my hard drive. Sometimes happens with my trying to post links. I’ll try again and hope it comes through.
http://www.nationalcenter.org/NPA557_Cuban_Health_Care.html
For the benefit of some people on this blog I am speaking metaphorically. I do not literally believe little demons are running around in my hard drive.
I think that basically every single person in the US should be required to read the 20,000-word Time Magazine special article Bitter Pill. No, its author does not argue in favor of single-payer systems; he does not argue in favor of any specific kind of system at all, though towards the end he does suggest some ideas to reform our current system. The article is not an argument but rather an examination of some of the biggest, and costliest, flaws in our system. It is laughable and absurd to ignore the realities that make the US healthcare system one of the most expensive and least accessible in the world.
I don’t believe that you can find the entire article online but I’m sure you can find it at a library. It is nonpartisan, eye-opening, and infuriating.
In the meantime, here is an infographic containing some of the numbers (but none of the examination) in the article: http://healthland.time.com/2013/02/20/what-makes-health-care-so-expensive/ It mentions the operating profit of certain non-profit hospitals, as well as CEO compensation, because in the article much attention is given to the fact that many medicines and products given to patients are marked up by, literally, hundreds of percents. That markup is in addition to the technician and facility cost, etc, so a 300% markup on a medication is literally just a markup on that medication, for example. In addition some attention is paid to the double- or triple-billing of patients that is also not uncommon – charging. The examination of the profits of non-profit institutions is not class warfare but rather a continuation of an examination that begins with the gross overcharging that occurs in the rooms of that hospital. I just thought I should mention that before somebody thought it was just profit-shaming or something. It is UNETHICAL profit-shaming.
Hi Alexandra,
Certainly the US health care system isn’t perfect, but I’m convinced when third party payer and government interference stepped in, it created only chaos, inefficiency, and enormous expense. From what I have posted we can see that Obamacare will do nothing but generate more expense and inefficiency.
The plastic surgeons in our city must compete for business, except where reconstructive surgery is medically necessary and covered by insurance. Its keeps prices competetive, service top notch, and them in business. It also helps keep me in job!
At one time, and I remember it well, all doctors and hospitals had to do the same. If you served a middle class community, you couldn’t charge thousands and stay in business. What grocery store do you know of routinely charges its customers hundreds of dollars each time they shop for basics and stays in business? Over the years I have seen the very people who cry “victim” badly abuse the system. Like midnite ER visits for a family of 6 kids with head colds when a visit to the pharmacy would suffice.
Not to say there aren’t abuses. The FDA is in my opinion a bastion of corruption right along there with Big Pharma.
Hey Mary –
I definitely think that third-party payers are one of the biggest problems in our system today! Interestingly, government healthcare (ie Medicaid) typically pays the lowest rates at hospitals, out of all the insurance companies. The rates that they pay are still rates that allow the hospital to operate at a profit – just not AS MUCH of a profit as the rates that private insurance companies pay (which is where the relevance of the operating profits comes in). This is essentially because the government researches and knows what a given item costs, and sets a rate based on that price plus profit margin, rather than negotiating down from the chargemaster, which is: basically secret; different from hospital to hospital; of virtually unknown origin; and almost entirely unrelated to the actual cost of hospital work. I wouldn’t have thought that at all and I don’t think it necessarily speaks to the efficiency of the government, as much as to the corruption of a system where the people choosing the product AND the people paying for the product aren’t the ones using it, and the people using it have little choice in whether they use it or not (ie, if the other choice is death, it’s not really a choice).
Oh and Jack, 3:34PM
I should extend an apology to you as well as EGV.
Hi Alexandra,
I gave your post a big like :)
“For the benefit of some people on this blog I am speaking metaphorically. I do not literally believe little demons are running around in my hard drive.”
Well that’s a relief, you had me worried there. ;)
Hi JDC,
LOL. You’d be surprised! I’ve spoken metaphorically before, assuming people knew I was, then talked down to and ridiculed about it. Sooooo, I just play it safe and post an advisory so as not to generate any confusion.
I must admit though, there are times I have to wonder if little demons are running around in my hard drive with all the headaches it gives me!!
Hi JDC,
Like the last time a major infection took over and it took 2 hours and $300 to get rid of it. I’d try to run my security system to get rid of it and it shut down the system. Talk about the inmates running the asylum. Anyway, the computer guy told me these viruses multiply and “possess” your computer. Like they have minds of their own.
So when I kid about demonic possession of my hard drive, well……..
Hi Mary,
Yes, I very much remember that not everyone exactly understood the whole Big Joe thing. So, yeah I guess the same people might not entirely get the demonic possesion thing either.
Aw, Mary, you are my fave. :)
Thank you Alexandra. I appreciate that.
You are one of my many very favorites on this site. :)
Mary-
About the Castro thing, one of the article even says that the doctor flew in with needed medical equipment that isn’t generally available in Cuba (maybe the doctor had some skills that don’t often get taught there because they don’t have access to a lot of the things the rest of the world does?), and the other article is quoting doctors that admit they have no first-hand knowledge of Castro’s condition or anything going on with him. They are basically educated guessing.
And with your National Center article, I’m not surprised that an organization with a stated goal of supporting free market healthcare would not view Cuba’s system positively. It’s like asking a Ron Paul libertarian to review the Fed! But I had to laugh at some of their complaints. They complain about medication shortages, blaming it on the system, when the shortages in Cuba are mostly the result of the trade embargo and US influence. After the Soviet Union fell shortages became more frequent since they weren’t getting any help from idk most of the world. They quote a few ex-pat doctors blaming it all on the system too, when most of the ex-pats (and I know a lot, even one doctor who hates communism and Castro but liked the healthcare system better in Cuba) I know never had any problem with the healthcare system.
But anyway, all opinions about their system aside, the results are pretty apparent. They are far, far better off healthcare-wise than most developing countries and a lot of developed ones, even with their other serious problems they got going on. Highest life-expectancy in the Caribbean, low infant mortality, low maternal mortality, low child mortality, etc. It’s not like everyone is dropping like flies because they live under socialized healthcare. Which was my point anyway. How in the world do you guys reconcile comparable (or even better than the US) outcomes in countries with universal healthcare, even in a poor developing communist embargoed country like Cuba, with your opposition to it? I don’t see why people think it’s so wrong to even take a look at what might work over here. It’s not like we have to throw out our system all together, but clinging to falsehoods like “the US has the best healthcare system on the planet!” is just insanity to me.
Hi Jack,
But if the Cuban healthcare system is so good, then there’s no need to bring in supplies, is there? Also, is this option available to the average Cuban citizen? My guess is under the same circumstances, they just make do and hope for the best. The sources on Castro’s condition were from the Spanish hospital where the surgeon who tended him works. The point is, why was it necessary to fly in a surgeon? Obviously something was seriously amiss with his care by Cuban doctors.
You may question the source concerning the National Center article but that doesn’t make it wrong. Also, they source what they say. Its a US trade embargo Jack, not a worldwide one. Any country that wants to trade with Cuba can. The Russians did for years. Maybe it has more to do with the failures of Castro’s economic system, which of course he blames on the US embargo since it gets him off the hook.
When did these ex-pats live in Cuba? A lot can change over the years. American doctors will tell you how much better things were in the past too.
No, everyone isn’t dropping like flies that lives under socialized health care. They aren’t here in the US either. I don’t believe we’re the best in the world, or anyone is. But I don’t believe government takeover which as we have seen has only led to corruption, waste, and out of control costs is any answer either.
As I’ve said I support far more personal responsiblity than what I see. People need to be informed and take control of their health. I support chiropractors and alternative medicine, it spared me back surgery and has enabled my diabetic husband to live 33 years with minimal complications.
Its been my experience that when something is perceived as ”free”, i.e. someone else is footing the bill, then its abused.
As for maternal and infant mortality rates as compared to the US, are women in these countries more inclined to see a doctor because they take the responsibility to do so? Are they more responsible for their own health and well being?
I pointed out the example of a nearby low income community where a doctor offered free prenantal care and not one woman came in. However these woman had no trouble finding the time and means to visit the local drug dealers, the McDonald drive thru, the liquor store, and the cigarette vendors. This was a matter of grave concern to this doctor but as he said, he couldn’t tie these women up and drag them in.
Lrning – individual cases aren’t brought in front if ipab. Essentially, if the cost of medicare escalates faster than a pre-defined pace, a committee recommends changes. Congress can alter those changes if needed – which might give them too much power, but again, it puts a shield in that you should be happy about.
Regardless, there’s a long history of insurance companies denying coverages for people – I’m not sure why you give them a free pass and then create myths when it comes to a future cost savings initiative.
Courtnay – pleanty of things:
1) I don’t like Obama’s abortion stance – I believe that he’s backed away from trying to make it rare and has too strongly embraced the financial side of the abortion industry (softened his language because of the money trail).
2) I feel that in debates like the debt ceiling and taxes, he’s far too quick to compromise.
3) I feel like he hasn’t done enough to build bridges with moderate Republicans.
4) I think he should have more fully embraced Simpson-Bowles when it first came out.
I’d be interested if you could match my four negative things with four positive things Obama has done? Or do you simply see the negative in everything?
Mary – I’ve posted links dispelling your line of argument regarding Canada. Do you want me to repost that so that you can read it again? Not sure why it hasn’t rubbed in for you yet.
Alexandra –
That Time magazine article is a great read – thanks for pointing that out.
Unfortunately, while the proposals made in the article make sense, they seem to fly in the face of what right wingers love – free market. Tax profits higher? Limit salaries? Cap price?
If I remember right as well, that article talked about the profits of medical device companies – and already, people are freaking out about taxing them a bit more (though their profits are insanely high).
Single payer is on the way – I have very little doubt, and have heard hospital CEO’s (of very large systems) saying the same thing.
EGV,
I have shown you links that Canada contracts with American hospitals for health care. What’s your issue?
EGV,
Its the Democrats in the Senate who have freaked out about the medical device taxes.
Mary –
Both parties freaked out about it – I can post the voting tally if you’d like. Again though, they didn’t have the corresponding cut or tax revenue to offset the lost revenue – so it was an easy vote when you are simply saying to get rid of something without naming how to offset it.
On Canada – facilities on both side of the border work together – it is good medicine. And people from both sides of the border go the other way for services. Heck, even Sarah Palin has received medical coverage in Canada.
If you want to keep talking Canada though, I’ll ask you – we pay roughly double per capita what Canada does for health care. Overall, do you think our system is twice as good as Canada’s?
” But if the Cuban healthcare system is so good, then there’s no need to bring in supplies, is there? Also, is this option available to the average Cuban citizen? My guess is under the same circumstances, they just make do and hope for the best. The sources on Castro’s condition were from the Spanish hospital where the surgeon who tended him works. The point is, why was it necessary to fly in a surgeon? Obviously something was seriously amiss with his care by Cuban doctors.”
Um, Cuba’s under immense world pressure because of their relations with the US, it’s quite difficult for them to obtain needed supplies especially with their economic problems on top of the issues they have with trade. A lot of countries won’t risk their relationships with the US (Canada surprisingly is quite cordial with Cuba even under pressure from us). And in addition to the embargo and US pressure on other countries, Castro burnt a lot of bridges with a lot of different countries with his politics and the groups he supported in Latin America, and his relationship with the Soviet Union didn’t help Cuba much especially after the Soviet Union collapsed. They also have problems with their relations with Europe because of their human rights (or lack of) record. So yeah, I actually find it quite stunning that their healthcare situation isn’t quite a bit worse with what’s going on politically and economically. And of course flying a doctor in for surgery is beyond the average Cubano, it’s beyond the average US citizen! The heads of government are going to get special treatment under any system, especially a dictatorship! You think if Obama or Boehner or Scalia or whoever were dying they wouldn’t go to the best of the best, even if the best was in another country? (which is common, a lot of wealthy US citizens go to specialists in places like Germany).
” When did these ex-pats live in Cuba? A lot can change over the years. American doctors will tell you how much better things were in the past too.”
I talk to people who lived in Cuba at different times. One of the people I talked to has only been here a couple years and is flabbergasted by how terrible our healthcare is in his eyes. He likes that he can buy stuff like cough medicine with no wait though. A lot of the older people came over right after the Batista government was overthrown, they don’t have as positive of an opinion of Cuban healthcare as the people I have talked to that lived under socialized healthcare with the Castro government.
About the rest of your comment. I don’t think “government takeover” is the option most people are going for. I would prefer a system like Australia’s to that. I do believe there is a lot to be learned from the decent outcomes in countries with universal healthcare (such as the fact that if you don’t get people preventative care and maintenance for chronic healthcare concerns, they are going to eventually cost a lot more money).
Hi Jack,
You may find this article interesting. It doesn’t seem Cuba is having much problem in the trade department.
http://nationsencyclopedia.com/Americas/Cuba-FOREIGN-TRADE.html
You point out the less than impressed ex-pat, I can point out Canadians who moved heaven and earth to get here for their health care.
Concerning preventative care, what stops anyone from getting it now or taking the personal responsiblity to protect their health? I recently encountered a seriously ill diabetic woman, in the ICU, who told us she smokes 2 packs a day with no intention of quitting. This is what I mean by personal responsiblity Jack, or should I say lack of it.
I’m a great case in point. A few years ago I was diagnosed with glaucoma. I saw the eye doctor for another problem, something minor. He discovered the glaucoma by default. I’ve actually had some visual loss and he monitors me closely. Now who’s fault is it that I didn’t go for regular eye exams as I certainly know I should, especially since I’m no spring chicken? There are no shortage of eye doctors in the community. I just didn’t get around to it. A great example of lack of personal responsility.
EGV 10:20PM
LOL. Come on EGV, admit it. The Democrats who supported Obamacare freaked out when they finally found out what was in it and how the medical device tax would PO their constiuents who make their living working for the eeeeeevil medical device companies. You gotta admit, its rich.
Of course the Republicans supported the repeal. You expected otherwise?
EGV, the Canadian gov’t contracts with our hospitals to provide services to their citizens. If you recall the article I posted it was because these same services are either not available in Canada or they mean a waiting list. It made great economic sense for the American hospitals and the Canadian gov’t that was unable or unwilling to better provide the services. My point is, why was this even necessary?
We pay double? Given the corruption, inefficiency, and waste of government programs and abuses of insurance, that’s no surprise. Maybe the good old free market system that you so loathe is the answer after all.
Hi Jack,
I suppose I should learn to spell. R-E-S-P-O-N-S-I-B-I-L-I-T-Y. There, I got it! :)
False Education: here is the AAP policy: Prevention of Respiratory Syncytial Virus Infections: Indications for the Use of Palivizumab and Update on the Use of RSV-IGIV
Committee on Infectious Diseases and Committee on Fetus and Newborn
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ABSTRACT
The Food and Drug Administration recently approved the use of palivizumab (pal?-vizh?-mäb), an intramuscularly administered monoclonal antibody preparation. Recommendations for its use are based on a large, randomized study demonstrating a 55% reduction in the risk of hospitalization attributable to respiratory syncytial virus (RSV) infections in high-risk pediatric patients. Infants and children with chronic lung disease (CLD), formerly designated bronchopulmonary dysplasia, as well as prematurely born infants without CLD experienced a reduced number of hospitalizations while receiving palivizumab compared with a placebo. Both palivizumab and respiratory syncytial virus immune globulin intravenous (RSV-IGIV) are available for protecting high-risk children against serious complications from RSV infections. Palivizumab is preferred for most high-risk children because of ease of administration (intramuscular), lack of interference with measles–mumps–rubella vaccine and varicella vaccine, and lack of complications associated with intravenous administration of human immune globulin products. RSV-IGIV, however, provides additional protection against other respiratory viral illnesses and may be preferred for selected high-risk children including those receiving replacement intravenous immune globulin because of underlying immune deficiency or human immuno-deficiency virus infection. For premature infants about to be discharged from hospitals during the RSV season, physicians could consider administering RSV-IGIV for the first month of prophylaxis.
Most of the guidelines from the American Academy of Pediatrics for the selection of infants and children to receive RSV-prophylaxis remain unchanged. Palivizumab has been shown to provide benefit for infants who were 32 to 35 weeks of gestation at birth. RSV-IGIV is contraindicated and palivizumab is not recommended for children with cyanotic congenital heart disease. The number of patients with adverse events judged to be related to palivizumab was similar to that of the placebo group (11% vs 10%, respectively); discontinuation of injections for adverse events related to palivizumab was rare.
Prophylaxis to prevent respiratory syncytial virus (RSV) infection in infants and children at increased risk for severe disease, particularly those with chronic lung disease (CLD) receiving medical management on a long-term basis, is now available using either an intravenous or an intramuscular preparation. Choosing which product to use in individual patients will depend on age, availability of intravenous access, cost, and other factors. Neither preparation is approved by the Food and Drug Administration (FDA) for infants or children with congenital heart disease (CHD). Unlike respiratory syncytial virus immune globulin intravenous (RSV-IGIV), recipients of palivizumab do not require delaying measles-containing vaccine or varicella vaccine.
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BACKGROUND
RSV-IGIV (RespiGam, Massachusetts Public Health Biologic Laboratories, and MedImmune, Inc, Gaithersburg, MD) was licensed by the FDA in January 1996 for prevention of severe RSV lower respiratory tract disease in infants and children younger than 24 months with CLD or a history of premature birth (?35 weeks of gestation). Recommendations for the use of this product have been summarized previously by the American Academy of Pediatrics (AAP).1 Randomized, controlled clinical trials demonstrated the efficacy and safety of monthly RSV-IGIV infusions in selected infants.2,,3 Although RSV-IGIV was the first agent with demonstrated efficacy for prophylaxis against RSV infections, and did provide a 41% reduction in RSV hospitalizations, several disadvantages are associated with this product. On the basis of available clinical trials, the safety and efficacy of RSV-IGIV in children with CHD has not been established. Children with cyanotic CHD who received RSV-IGIV and underwent cardiac surgery appeared to experience an increased surgical mortality rate.4 RSV-IGIV prophylaxis requires monthly intravenous infusion throughout the RSV season, and like palivizumab is costly.5 Also, a widespread shortage of RSV-IGIV during the past two winter seasons made supplies unreliable. The need for alternative approaches to the prophylaxis of RSV infection in high-risk infants is apparent.
A recent study using a RSV intramuscular monoclonal antibody, palivizumab, (Synagis, MedImmune, Inc, Gaithersburg, MD) provided an alternative approach to the prevention of RSV infections in high-risk infants. Palivizumab is a humanized monoclonal antibody directed against the F glycoprotein of RSV—a surface protein that is highly conserved among RSV isolates.6 Because the monoclonal antibody is not derived from human immune globulin, it is free of potential contamination by infectious agents and can be produced readily in batch lots; thus, shortages are not anticipated. The recently completed IMpact-RSV clinical trial defines the usefulness of this product for prevention of RSV disease in high-risk infants.7 Palivizumab was approved by the FDA in June 1998 based on the results of this trial. This statement summarizes existing data on palivizumab and provides recommendations concerning its appropriate use in clinical practice. Previous policy from the AAP has described other aspects of RSV disease: epidemiologic characteristics, risk factors for serious illness, laboratory diagnosis, and treatment with ribavirin8 as well as use of RSV-IGIV.1
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CLINICAL STUDIES
Clinical Efficacy of Palivizumab
During the winter of 1996 and 1997, 1502 infants were enrolled in a multicenter, double-blind, randomized clinical trial of palivizumab (2:1 enrollment, treated vs placebo group). At 30-day intervals, starting at the onset of the RSV season, 5 intramuscular doses (15 mg/kg) of either palivizumab or a placebo were administered. Children eligible for participation in the clinical trial were younger than 2 years with CLD who required continuing medical therapy (supplemental oxygen, bronchodilator, and diuretic or corticosteroid therapy) and children 35 weeks of gestation or less who were younger than 6 months at the start of the RSV season. The primary endpoint was efficacy of prophylaxis in reducing the incidence of hospitalization for RSV infections. Secondary endpoints included the total number of hospital days attributable to RSV as well as other respiratory viruses, days of supplemental oxygen therapy, days of altered respiratory illness score (the respiratory illness score included work of breathing, respiratory rate, retractions, and oxygen requirements [greater than 3 days]), days of intensive care unit (ICU) management, days of mechanical ventilation use, and incidence of otitis media.
One hundred thirty-nine sites in the United States, Canada, and the United Kingdom participated in this clinical trial. Placebo and prophylaxis groups were balanced at the beginning of the study for demographics and RSV infection risk factors (ie, prematurity, neonatal CLD). Prophylaxis resulted in a 55% overall reduction in RSV-related hospitalizations (11% to 5% in placebo vs palivizumab recipients, respectively, P < .001). Small differences in rates of hospitalizations were noted between placebo and prophylaxis groups in different geographic regions. These rates were 10% prophylaxis compared with 5% placebo for the United States, 15% prophylaxis compared with 9% placebo for Canada, and 10% prophylaxis compared with 4% placebo for the United Kingdom.
The number of days of hospitalization for RSV infection per 100 children was decreased from 62 in patients receiving a placebo to 36 in those receiving palivizumab (P < .001). Clinical benefit could be ascribed for additional secondary endpoints (Table 1), including decreased requirement for supplemental oxygen, a decrease in the number of days of moderate or severe lower respiratory tract illness per 100 children (illness severity score), or a reduction in the requirement for hospitalization in an ICU. No statistically significant differences were identified for the requirement of mechanical ventilation or in the incidence of otitis media.7 The mortality rate was low in both study populations. Among placebo recipients, 5 children died (1%) compared with 4 children who received palivizumab (0.4%). Hospital deaths during the study occurred in 2 of the palivizumab recipients, 1 attributed to aspiration and the other to complications of liquid ventilation in a child with RSV pneumonia.
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Table 1.
Prevention of Respiratory Syncytial Virus Infections: Indications for the Use of Palivizumab and Update on the Use of RSV-IGIV
Adverse events were not significant. Overall, the development of erythema, pain, and induration at the site of intramuscular injection resulted in adverse events in 2% of the placebo recipients and in 3% of infants receiving palivizumab.7 There were no significant differences in adverse event rates or the appearance of antibody to the monoclonal antibody.9 No data are available regarding the potential for adverse events or therapeutic efficacy in a second year of administration.
Subgroup Analyses
Palivizumab reduced the severity of clinical illness in all subgroups evaluated (Table 2). Premature infants without CLD had an overall 78% reduction in hospitalization (8% in the placebo group vs 2% in the palivizumab group,P < .001). Premature infants with CLD showed a 39% reduction (13% in the placebo group vs 8% in the palivizumab group,P = .038). Although the overall number of children in the clinical trial allowed for comparisons of smaller groups, these assessments should be considered retrospective and exploratory.
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Table 2.
Prevention of Respiratory Syncytial Virus Infections: Indications for the Use of Palivizumab and Update on the Use of RSV-IGIV
In a retrospective subgroup analysis, reduction in the rate of RSV-associated hospitalizations from 10% in the placebo group to 1.8% in the palivizumab group was noted for children born between 32 and 35 weeks of gestation who did not have CLD. However, lower rates of hospitalization have been documented for children of similar ages who received no therapy.10
Overall Considerations
As noted earlier, palivizumab decreases risk of severe RSV disease, as does RSV-IGIV. No direct studies were done to compare relative efficacy of the two products. Palivizumab is not a human blood product and, therefore, is not associated with risks of acquisition of blood-borne pathogens, a potential risk with RSV-IGIV. Because of its ease of administration, palivizumab is favored over RSV-IGIV (1 intramuscular injection vs a 4-hour intravenous infusion). Furthermore, the availability of palivizumab is not contingent on the blood donor pool. Currently, palivizumab is only available in an intramuscular formulation; however, an intravenous formulation will likely be available in the near future. The only rationale for such a formulation is to provide the capability of administering this product intravenously if the infant has an intravenous line in place for other reasons.
Escape mutants (ie, resistant viruses) to palivizumab have not been identified after the administration of this product; however, the administration of other monoclonal antibodies has been associated with development of such resistant mutants. Surveillance will be required to identify the risk for such events.
A critical aspect of RSV prevention in high-risk infants is the education of parents and other caregivers about the importance of reducing exposure to and transmission of RSV. Preventive measures include eliminating exposure to cigarette smoke and limiting exposure to contagious settings (eg, child care centers). Emphasis on hand-washing in all settings, including the home, especially during periods when contacts of high-risk children have respiratory infections or are at high risk for exposure to respiratory infections from siblings who are in child care or attend school, is also important.
Clinical Selection of RSV-IGIV Over Palivizumab
Although palivizumab provides effective protection against RSV for eligible infants, and has greater ease of administration and fewer adverse effects than RSV-IGIV, there may be certain considerations that might favor the use of RSV-IGIV. Specifically, in the RSV-IGIV trial, immunoprophylaxis decreased the overall rate of hospitalizations for non-RSV respiratory infections, whereas palivizumab did not. This may be of value in those infants younger than 6 months who are not eligible for influenza vaccination as well as for those infants and children with severe pulmonary disease for whom respiratory infections other than those caused by RSV may be medically important. Similarly, there was a statistically significant reduction in the overall frequency of otitis media, although this latter point alone is unlikely to justify use of RSV-IGIV. Palivizumab has not been tested in the treatment of children with CHD. Neither product is licensed by the FDA for use in children with CHD, and RSV-IGIV should not be administered to children with cyanotic CHD.
Administration
Palivizumab is administered intramuscularly in a dose of 15 mg/kg once a month during the RSV season. Palivizumab is packaged in 100-mg vials, and opened vials must be used within 6 hours. To minimize wastage, physicians should arrange for administration so that 2 or more eligible patients can receive the vaccine within the 6-hour period after opening a vial. RSV-IGIV is administered intravenously in a dose of 750 mg/kg once a month during the RSV season.
Vaccination
Palivizumab does not interfere with vaccine administration. Infants and children receiving RSV-IGIV prophylaxis (750-mg/kg dose) immunization with measles–mumps–rubella (MMR) and varicella vaccines should be deferred for 9 months after the last dose. (See Table 3.37 on page 353 of the 1997 Red Book.11) There are no data on the use of RSV-IGIV and the response to hepatitis B vaccine, but there is no reason to anticipate interference because RSV-IGIV does not contain antibodies to hepatitis B surface antigen. RSV-IGIV use should not alter the primary immunization schedule for diphtheria and tetanus toxoids, whole-cell or acellular pertussis, Haemophilus influenzae type b, and poliovirus vaccines (inactivated poliovirus vaccine [IPV] or oral poliovirus vaccine [OPV]). The manufacturer of RSV-IGIV has suggested that an additional dose of vaccine might be needed to assure an adequate immune response to diphtheria and tetanus toxoids, whole-cell or acellular pertussis, Haemophilus influenzae type b, and OPV (refer to the RespiGam package insert), but more information is needed before changes in current immunization recommendations can be made. Currently, the available data do not support the need for supplemental doses of routinely administered vaccines. Parenterally administered immunoglobulin preparations have little, if any, effect on the replication of OPV in the intestinal tract.
Cost-benefit Analyses
Only limited cost-benefit analysis data are available for RSV-IGIV, and no peer-reviewed data are available at this time for palivizumab. Cost-benefit analyses of RSV-IGIV did not demonstrate an overall savings in hospitalization considering the costs of therapy for all at-risk children.12,,13 Although results of another study were more favorable, different methods were used.5
Factors other than CLD influence the decision about use of prophylaxis, particularly in children with a gestational age of 32 to 35 weeks, including other underlying conditions that predispose to respiratory complications (eg, neurologic disease in very low birth weight infants), number of young siblings, child care center attendance, exposure to tobacco smoke in the home, anticipated cardiac surgery, and distance to and availability of hospital care for severe respiratory illness. For many infants qualifying for the approved indications, risk of rehospitalization for serious respiratory illness will be low, and the cost and logistical difficulties associated with prophylaxis may outweigh the potential benefits.
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RECOMMENDATIONS
1.? Palivizumab or RSV-IGIV prophylaxis should be considered for infants and children younger than 2 years of age with CLD who have required medical therapy for their CLD within 6 months before the anticipated RSV season. Palivizumab is preferred for most high-risk children because of its ease of administration, safety, and effectiveness. Patients with more severe CLD14 may benefit from prophylaxis for two RSV seasons, especially those who require medical therapy. Decisions regarding individual patients may need additional consultation from neonatologists, intensivists, or pulmonologists. There are limited data on the efficacy of palivizumab during the second year of age; risk of severe RSV disease exists for children with CLD who require medical therapy. Although those with less severe underlying disease may receive some benefit for the second season, immunoprophylaxis may not be necessary.
2.? Infants born at 32 weeks of gestation or earlier without CLD or who do not meet the criteria in recommendation 1 also may benefit from RSV prophylaxis. In these infants, major risk factors to consider are gestational age and chronologic age at the start of the RSV season. Infants born at 28 weeks of gestation or earlier may benefit from prophylaxis up to 12 months of age. Infants born at 29 to 32 weeks of gestation may benefit most from prophylaxis up to 6 months of age. Decisions regarding duration of prophylaxis should be individualized, according to the duration of the RSV season. Practitioners may wish to use RSV rehospitalization data from their own region to assist in the decision-making process.
3.? Given the large number of patients born between 32 to 35 weeks and the cost of the drug, the use of palivizumab in this population should be reserved for those infants with additional risk factors (see “Cost-benefit Analyses” section) until more data are available.
4.? Palivizumab and RSV-IGIV are not licensed by the FDA for patients with CHD. Available data indicate that RSV-IGIV is contraindicated in patients with cyanotic CHD.4 However, patients with CLD, who are premature, or both, who meet the criteria in recommendations 1 and 2 and who also have asymptomatic acyanotic CHD (eg, patent ductus arteriosus or ventricular septal defect) may benefit from prophylaxis.
5.? Palivizumab or RSV-IGIV prophylaxis has not been evaluated in randomized trials in immunocompromised children. Although specific recommendations for immunocompromised patients cannot be made, children with severe immunodeficiencies (eg, severe combined immunodeficiency or severe acquired immunodeficiency syndrome) may benefit from prophylaxis. If these infants and children are receiving standard immune globulin intravenous (IGIV) monthly, physicians may consider substituting RSV-IGIV during the RSV season.
6.? RSV prophylaxis should be initiated at the onset of the RSV season and terminated at the end of the RSV season. In most areas of the United States, the usual time for the beginning of RSV outbreaks is October to December, and termination is March to May, but regional differences occur.15 The onset of RSV infection occurs earlier in southern states than in northern states.16Practitioners should contact their health departments and/or diagnostic virology laboratories in their geographic areas to determine the optimal time to begin administration.
7.? RSV is known to be transmitted in the hospital setting17 and to cause serious disease in high-risk infants.18–20 In high-risk hospitalized infants, the major means to prevent RSV disease is strict observance of infection control practices, including the use of rapid means to identify and cohort RSV-infected infants.21 If an RSV outbreak is documented in a high-risk unit (eg, pediatric intensive care unit), primary emphasis should be placed on proper infection control practices. The need for and efficacy of prophylaxis in these situations has not been evaluated.
8.? The guidelines for modification of immunizations after RSV-IGIV have not changed. Palivizumab does not interfere with the response to vaccines.
Committee on Infectious Diseases, 1998–1999
Neal A. Halsey, MD, Chairperson
Jon S. Abramson, MD
P. Joan Chesney, MD
Margaret C. Fisher, MD
Michael A. Gerber, MD
S. Michael Marcy, MD
Dennis L. Murray, MD
Gary D. Overturf, MD
Charles G. Prober, MD
Thomas N. Saari, MD
Leonard B. Weiner, MD
Richard J. Whitley, MD
Liaison Representatives
Robert F. Breiman, MD
National Vaccine Program Office
M. Carolyn Hardegree, MD
Food and Drug Administration
Anthony Hirsch, MD
AAP Council on Pediatric Practice
Richard F. Jacobs, MD
American Thoracic Society
Noni E. MacDonald, MD
Canadian Paediatric Society
Walter A. Orenstein, MD
Centers for Disease Control and Prevention
N. Regina Rabinovich, MD
National Institutes of Health
Ben Schwartz, MD
Centers for Disease Control and Prevention
^TL;DR
Mary -
It was an easy vote because it’s non binding – and it gives plenty of people cover for their next election. ”Yes, I wanted to get rid of the device tax, but then we could never find the proper tax offsets, so it never came to an official vote”. Non-binding votes are awesome – allows a politician cover for something without ever having to commit to anything.
You should read that Time article to see how well the free market is working out. Bottom line, health care isn’t like BMW’s. At the end of the day, if a poor person has a heart attack, society hasn’t said that this person won’t get care because they can’t afford it. With BMW’s, if you can’t afford it, you walk away. So our free market already has a socialistic aspect built in – if you can’t afford it, you get care anyway, with costs passed to others.
EGV,
Easy vote, non binding. Sure its politics. LOL. Admit it EGV, the Democrats got caught with their pants down and are trying to weasel their way out.
EGV, we don’t have free market medicine and haven’t for a long time. We have third party payment. We have gov’t involvement. We have the resulting out of control costs and corruption that comes with it. We have people who feel no obligation to pay their hospital bills because somehow they are owed “free” care and the cost is passed on to all of us.
I cannot understand why people continue to proclaim the benefits of single payer when , if you spend more than 5 minutes reading/watching the MSM, you can see such clear examples of how it doesn’t work in Canada and England.
Mary:
Thanks for your comment. I surely appreciate all you have done to expose Obamacare. Tireless advocacy of the truth will eventually win out, even if it takes a few generations.
Ex says:
Non-binding votes are awesome – allows a politician cover for something without ever having to commit to anything.
Hmmm. What is this…politicians already manipulating aspects of Obamacare to pander to constituencies? How could this be? Who could have predicted such a thing? Well, get used to it because thanks to Obamacare all things pertaining to healthcare and how to pay for it are now subject to political manipulation.
If you reply, ex, please show me where I said “death panels” in my 11:17 post. Your rant against my post took me to task for “death panels” even though what I clearly said was the following: “… but if the rationing board decides they are too old or othewise deemed ineligible for certain procedures–tough luck”. Clearly you do not understand that IPAB will have much, much more to say about setting the parameters of health care delivery for every age group and cycle of life than you realize, and that is what I was referring to. Their decisions will be looked to by everyone in the health care industry and by government directed programs in particular as to what practices will be permitted and to what degree they will be paid for.
Having said that I do not quibble with the assertion that their decisions in some cases will have life and death implications. This cannot be denied by anyone grounded in reality. Already Medicare is cutting back on the amount they will pay for certain procedures thereby effectively preventing the delivery of care to those who cannot pay the difference. This is exactly the type of thing IPAB will be doing–setting “payment advisories” (their very mission), and not just on the aged, but on all groups.
Jill posted a video here of a mom singing to her daughter of 18 who was dying. The daughter had been treated 4 times for recurring bouts of cancer and in the end she couldn’t beat it. I can see a future IPAB ruling limiting the number of times life saving attempts at beating cancer will be paid for under Obamacare guidelines. In this example and thousands of others to come all health care decisions will be made with the 800 pound government gorilla in the examining room.
In the end what Obamacare is doing is profoundly evil. It is effectively taking away from us the ability to control the most consequential decisions many of us will make in our lives and handing them over to the bureaucrats.
Jerry,
Many are deluded into willingly trading control of their own health care decisions for the lie/fairy tale of free government care for them.
Speaking of the wonders of Cuban healthcare Hugo Chavez very likely would have at the very least extended his life had he availed himself instead to real medical care. One might say that Hugo Chavez is the poster boy with all that is wrong with the great socialist experiment when it comes to health care. Alas, he had boxed himself in and could not be seen as going against his seething against the U.S. in particular and capitalism in general. So off to the glorious paradise of socialism he went for the cure.
Truthseeker:
Yes, and as it has often been said: The government that can give you everything can also take it away.
I love how some of you completely ignore everyone’s arguments in favor of your rhetoric.
I didn’t know you were doctor, Jerry.
“I love how some of you completely ignore everyone’s arguments in favor of your rhetoric.”
Yeah, it’s one of the many reasons I generally steer clear of healthcare debates on this blog.
JDC hush you live under “socialized healthcare”, you’re dead.
Mary, the Cuban economy is slowly improving due to new and better relations with several countries, especially since they’re getting all chummy with China and working closely with Venezuala and all. Also, I believe the US has lost a lot of it’s influence on other countries in later years, which also probably didn’t hurt them.
I don’t think a lack of personal responsibility accounts for most of healthcare problems. Heck, Australia has a higher smoking rate and a huge obesity problem, but they still have better outcomes than us. And they spend way less money.
Jerry,
or as Benjamin Franklin said; “he who trades liberty for safety deserves neither”
Yeah, Canada, Australia, the UK. They are all bastions of communism and human rights deprivation. All because of their healthcare system.
I just love how not even the type of cancer Chavez had is known by any of us, but somehow some random dude knows if he came to the US to see “real doctors” then he’d be alive.
Hi Jack,
The point is the US trade embargo has never stopped anyone who wanted to from trading with Cuba and for decades the Cubans traded with the Soviets and her allies. Also, the entire world did not view Castro with contempt and like us. Castro was hailed as a hero by many. To me he’s no worse or better than some of the tyrants and dictators we have climbed into bed with.
I’m saying personal responsibility plays a very essential role. Its not the end all be all. Nothing says otherwise obese or large people can’t keep themselves active and in good health. Oprah seems to have done very well. People smoke their entire lives and die of old age. People do everything “right” and die of cancer.
Recently my eye doctor expressed his frustration to me about his patients who don’t follow their eye drop regimen for glaucoma. Believe me, it ain’t rocket science. This means starting the regiman over again, adding new drops, the disease in the meantime has advanced, more expense, complications, and possible surgery. Another example of unnecessary expense and complications.
Ironically, this, and the pregnant women I mentioned are both examples that have occured under ”socialized” medicine. The pregnant high risk women were offered free prenantal care, not one woman came in. The glaucoma patients were Medicare. Free market or socialized, people have to be responsible. What do you do if they’re not? Create yet another government bureaucracy to lead us around by the hand? Believe it or not JackI have heard this suggested.
I never claimed our health care system is the best in the world. Believe me, I could write a blog on what I think is wrong with it. Don’t even get me started on our “care” of the mentally ill. There is no panacea anywhere, and that is what I try to point out. Government interference helped create this mess and now we trust them to correct it?
Kristin –
And if you spend two minutes, you’ll find why our current system is more broken.
Jerry –
You write as if the alternative is some medical system in which everyone gets all the care that they want, whenever they want it.
You write as if the alternative to health care reform, the status quo, sees no difference between poor and rich, those with and without means, the insured and uninsured.
You write as if you have some sort of solution out there that works better.
If you truly believe that individuals will be looked at to see if they are too old or not for certain care – then again, there’s not much sense in arguing with you until you read more about the law, how IPAB works, and the controls around it. Look it up and then get back to me.
Ex:
Still waiting to see where I said “death panels” as you claimed I did. I gave you a real world explanation of how IPAB will work based on the Canadian and British socialized health care models. Ignore this reality at your own peril.
You like Obamacare because your hero is Obama and you are a self-professed liberal who likes big government programs. Does it trouble you in the least that Obamacare strips $700 billion from Medicare, and in Obama’s budget just released he wants another $300 billion taken out of Medicare?
Obama’s raiding of Medicare…a program millions of people have actually paid into whether we wanted it or not…is immoral. We were told that Medicare would be the answer to our health care needs in our later years and we contributed to it for the major part of our employment only to see premiums increase and coverages reduced. This reduced funding of Medicare is happening as record numbers of people are entering the system and Obama’s response is to steal money from Medicare to give it to millions of people, many of whom have not paid a dime into the health care system of their own choosing.
The question has to be asked: What does Obama have against people on Medicare? If the majority of Medicare recipients comprised his political base you can bet this raid on Medicare would not be happening.
Did you see Mary’s link to the hiring of Obamacare “navigators”? This is just wonderful…having to spend additional millions of dollars on cushy government jobs to tell people how to go to the doctor.
“We were told that Medicare would be the answer to our health care needs in our later years and we contributed to it for the major part of our employment only to see premiums increase and coverages reduced. ”
This reminds me of Ayn Rand complaining about how immoral social safety nets and government retirement funding was, and then jumping on receiving benefits for herself when she was eligible. I think it’s hilarious to watch you guys rail and whine about poor people not paying their fair share and how everyone wants something for free (which isn’t even flipping true for most people), and then complain because YOU might not get your “entitlements”. Why don’t you use some personal responsibility and save up for your own retirement medical needs?
Hello Jack:
I do not understand why you ask if I am a doctor. What is the point? I would not think being a doctor is a prerequiste to commenting here as that would wipe out the majority of comments on this thread. Are you saying you are a doctor?
Sigh.
Jerry, Jerry, Jerry. Come on man.
First of all, you explain almost word for word the conservative lies about ipab, and then when I use the word they do (death panel), you all of the sudden cringe and yell “I didn’t say that”.
The fact of the matter is, you have no idea how ipab works, and should probably read up on it.
Also, why in the world would you base your assumptions off of other countries? Do you not have faith in this country? Do you not see any difference between ours and theirs? We didn’t cut and paste their laws into our system. It’s baseless to make assumptions like that.
And Medicare…if I’m you Jerry, I apologize for your confusion on this all, and move on to other subjects. First off, do you know who else has proposed cutting medicare as of late? Paul Ryan, John McCain, the entire GOP. And now you have the nerve to yell about Obama? Furthermore, he isn’t cutting it – he’s decreasing future increases by getting rid of some waste and fraud, decreasing payments to poor performing facilities, and getting rid of some programs.
Let me ask you this though, fundamentally, a question about Medicare. Under your best case scenario, since you seem to hate Medicare, how would you deal with things when outflows outpaced inflows? I’m assuming then since you hate cuts to the program, you’d raise taxes, correct?
Hello Jack:
Believe me, if I could have put my contributions to SS and Medicare into private accounts I surely would have. We were forced to contribute so it is only logical that we should expect to get something back in return.
On the other hand we have created an entitlement culture in our society where a great many people who don’t have a clue about how programs are paid for think they have a right to them. Beyond a safety net this can become burdonsome to the point of collapse.
Jack,
And there you have it – life according to the right.
If you pay taxes towards SS and Medicare, and then find yourself in a position to qualify for it, it isn’t an entitlement in a bad way.
If you pay taxes towards medicaid, unemployment, food stamp programs, and then find yourself in a position to qualify for it, it is an evil entitlement.
Who knew?
” I do not understand why you ask if I am a doctor. What is the point? I would not think being a doctor is a prerequiste to commenting here as that would wipe out the majority of comments on this thread. Are you saying you are a doctor?”
I thought the reason I made that comment was obvious. You implied (actually you outright stated) that you know that Chavez didn’t get “real” medical treatment because he went to Cuba (with their better than the US outcomes and a popular destination for healthcare tourism, I am pretty sure he got “real” healthcare there). I don’t understand how you know so much about Chavez’s health, seeing as he never released his diagnosis and information was pretty vague about it. The only way I can see you commenting about it with such certainty if you were a doctor that worked on him. :D
Ex:
It was Obamacare that took the money out of Medicare without the support of a single Republican vote.
I’m assuming then since you hate cuts to the program, you’d raise taxes, correct?
No, I am saying that they should not raid the program, that it is immoral to do so. Leave the billions of dollars in Medicare to go to the people that put them there.
“Jack,
And there you have it – life according to the right.
If you pay taxes towards SS and Medicare, and then find yourself in a position to qualify for it, it isn’t an entitlement in a bad way.
If you pay taxes towards medicaid, unemployment, food stamp programs, and then find yourself in a position to qualify for it, it is an evil entitlement.
Who knew?”
Yup. Exactly. What I find frustrating is the complaints about unemployment. That program literally, LITERALLY goes off what you have made, worked for, and put into the system. But if you take unemployment you’re obviously a leech and all that.
Jerry, you realize MOST people on “entitlements” besides unemployment and SNAP are elderly and disabled, right? The elderly people obviously put money into it, and what exactly do you suggest we do with disabled people (a lot of whom put money into the system to the best of their abilities, and some worked for years before becoming disabled)? You are not in some special class of the “good people” who deserve entitlements, you are like most Americans.
And as someone who makes well below the federal poverty line for income taxes, I can tell you that I DO pay into medicare and social security, the same percentage of income that anyone does that has an income at all! Actually, if you make more than the cut off, I pay more of a percentage of income. Explain how people aren’t paying into those programs?
Jerry.
So you don’t understand ipab, and you don’t understand Medicare.
Next?
Really, I want people to explain to me how poor people aren’t paying into entitlements. I can look at my pay stub right now and see that they take out the percentage they are supposed to for Medicare, and the percentage of Social Security too. Poor people simply don’t pay federal income taxes, sometimes, they don’t get a free pass on other taxes. I pay unemployment, Medicare, Social Security, sales tax, gas tax, sin taxes, etc etc etc. Someone needs to explain to me how the lower 47% isn’t contributing anything in taxes, I’m dying to know.
Hello Jack: 10:01
Thanks at least for the levity of the smile. It seems all I hear these days is that Cuban health care is great. It is implied that Hugo and others would do just fine under that program…and the assumption is it did not matter how sick he was. I did not take that to mean they knew exactly what kind of disease he had, nor that they were doctors.
My point is that if it was someone I loved who needed treatment for cancer it would not be my choice to send them to Michael Moore’s paradise.
Who is assuming that Cuban healthcare is… magic or something, and can cure people no matter how ill they are? It’s a healthcare system, with good points and bad points like any other. It has outcomes similar to or exceeding the US. Those are just facts. I don’t think the fact some old dude died of some unknown type of cancer and some unknown respiratory illness takes away from those facts.
Ex:
Next? Mary has spent countless hours in patiently explaining things to you. I have thrown in my 2 cents worth. Now, my friend, the next move is yours. You seem to be more interested in trying to score cheap debating points than learing how things really are.
Here is something for you to consider. If you are in your 30s or 40s don’t you think you know more now than when in your 20s? I challenge you to go to an accountant or someone who has been doing investing for years and see how they think all of these programs are going to be paid for. Seek out especiallly someone who does not agree with Obamacare. Don’t go to someone in their youth who does not have the experience or wisdom that comes with years. Go to someone who has been around a while and who doesn’t have an ax to grind. If you can convince this individual that they are wrong about not liking Obamacare then come back here and I will listen to you.
Hello Jack:
Judging from your enthusiastic embrace of Cuban health care it seems you would be willing to change our system to that model. But would you seriously send a loved one to Cuba for treatment of a serious cancer?
Jerry – Mary speaks fondly of a world that doesn’t exist anymore. She longs for medicine before third party payments, but doesn’t take into effect that we have procedures now that we didn’t have back then – things that cost lots of money. Now, it works if you treat medicine like cars, and if you can’t afford it, you simply don’t get treatment. With cars, you just take the bus. With healthcare, you die.
I don’t believe that is the type of system you want – let me know if you do.
I’ll give you a name – RicK Ungar. He writes for Forbes, turns 63 this year, has been in health care policy for years, and support Health Care Reform. He’d be a good start for you to learn about health care.
The simple fact of the matter is, you clearly read a few headlines from right wing news and let that shape your health care news. The reality is more complex. You rail about medicare cuts, which Paul Ryan’s newest budget keeps all medicare cuts in place. You pretend some world exists in which individuals will be decided if they are too old for treatment. You look for a speck in the eye of health care reform while ignoring the unsustainable nature of health care spending in this country.
Read up on some sites – seriously – it would do you good, and make you less scared about the future of health care in this country.
” Judging from your enthusiastic embrace of Cuban health care it seems you would be willing to change our system to that model. But would you seriously send a loved one to Cuba for treatment of a serious cancer?”
“Enthusiastic embrace”… I am pretty sure what I have been saying there are good points and bad points to the Cuban system, and to reject everything about socialized systems like that out of hand without looking at things we could possibly incorporate into our system to make it more accessible and sustainable.
Would I send someone I loved to Cuba for cancer treatment? Sure, why not? It’s not like anyone of my loved ones can afford good treatment here.
Why do you people who rail against poor people who “don’t pay taxes and want free stuff” completely ignore me when I point out that everyone who works and buys things at all pays taxes?
Jack – and people who hate deficits and raising taxes are pitching a fit about medicare cuts…when the only alternative would be to either raise taxes or run a deficit on the program.
It is why the GOP has lost and is dying – they complain, whine, complain more, but have no actual solutions to anything these days. They are in huge trouble now – if they move moderate, they lose the tea party right and those voters. If they keep those folks, they are never going to get out of the dark ages. As a former GOPer…it is painful to watch. I think ignorance and hypocritical attitude is what is really killing them. They love to talk about Reagan and Thatcher, and those two wouldn’t even go close to the modern day GOP.
I meant to say in my 11:12 comment that we shouldn’t reject everything about socialized or more universal systems without looking to see where they are successful and seeing what we can incorporate to make our system more accessible and sustainable.
” It is why the GOP has lost and is dying – they complain, whine, complain more, but have no actual solutions to anything these days. They are in huge trouble now – if they move moderate, they lose the tea party right and those voters. If they keep those folks, they are never going to get out of the dark ages. As a former GOPer…it is painful to watch. I think ignorance and hypocritical attitude is what is really killing them. They love to talk about Reagan and Thatcher, and those two wouldn’t even go close to the modern day GOP.”
I just don’t get how people rationalize some of the contradictions in their heads, it’s maddening. I know plenty of conservatives who are decent, smart people… but they don’t do this weird cherry-picking, whiny, irrational thing where they disregard any fact that doesn’t fit a certain world view. I don’t understand how people can completely disregard cold, hard, facts in favor of rhetoric.
My ex-father-in-law is very conservative and we used to get into huge arguments about the evil poor people draining the system, blah blah blah, but at least he admitted that health care in the US is unsustainable and it’s not the lower income levels fault.
Not that I’m saying people who do the cherry-picking, whiny, irrational thing are automatically bad people either, plenty of them are great human beings. I just don’t see how it’s logical at all to simply disregard any fact that you don’t like.
“Why do you people who rail against poor people who “don’t pay taxes and want free stuff” completely ignore me when I point out that everyone who works and buys things at all pays taxes?”
Jack, first off; nothing is free. And the leaches are the ones who feel they are entitled to things that belong to other people have just because they want them and the people they steal from have so much more. I have known people, who are genuinely good-hearted, who seriously don’t understand why it would not ok to steal something they need from a “rich” neighbor. Are you that kind of person?
” Jack, first off; nothing is free. And the leaches are the ones who feel they are entitled to things that belong to other people have just because they want them and the people they steal from have so much more. I have known people, who are genuinely good-hearted, who seriously don’t understand why it would not ok to steal something they need from a “rich” neighbor. Are you that kind of person?”
Well first off, no, I haven’t been that type of person since I was about eighteen, I believe, was the last time I ever stole anything. I’ve never been on food stamps, I’ve never been on Medicaid, I’ve never had housing assistance and the only time anyone else has ever paid for me to live somewhere was when I was underage and homeless and stayed in shelters a couple times. I qualify for much government assistance but the only assistance I take is state insurance for my kids because there really isn’t much choice there (and I pay state taxes, so I do contribute). You know this because I told you before.
Second, you guys tend to go on and on about these leeches, pointing out “entitlements” like Medicaid and SSI and the like, while ignoring the reality of the situation and blaming people for needing those services, stereotyping them in general as able-bodied people who don’t want to work/don’t want to buy their own health insurance. The reality of most people on “entitlements” is quite different. The statistics bear me out, not you. A lot of you insist on repeating the lie that poor people don’t pay any taxes and don’t feel the effects of higher taxes, which is completely, blatantly false but yet you keep saying it. And none of you seem willing to call out people on upper income levels who tax dodge and use loopholes while you’re complaining of people who make less than 20,000 a year who want health insurance so they don’t have to go to the ER for strep throat and the like. It’s maddening, it’s hypocritical, and it’s half insane in my opinion.
Jack, all I can say is you have it/me all wrong. People who need SSI or Medicaid deserve it. People who get debit cards for food and cash it at ATM’s in Casinos probably don’t deserve it. And if you followed this blog you have seen me rail against GE (until recently GE CEO Jeffrey Immelt was Obama head economic advisor), a multi-billion dollar company that pays no taxes.
I’m more talking in generalities from what I’ve seen from the conservative fringe (including some people on this blog) than directing it at you personally, truth. I’ve seen you say things I heartily disagree with, but also some things I agree with. I do need to stop with the “you guys” and stereotyping, I don’t like it when people do that to groups I somewhat belong to, I shouldn’t do it to others.
Yes, please. Most of us don’t rail against the poor, but the poorly run government.
Amen, Hans!
EGV 11:02PM
LOL. Yeah you got that right EGV. A world that doesn’t exist anymore. Let’s see, the iron lung wards where people would spend months on end, TB sanitariums, routine week long plus post surgical hospital stays. Orthopedic wards where patients would often spend weeks. You think these didn’t cost anything? I, and I’m sure Jerry, well remember this in our lifetime.
That’s what I’m pointing out EGV, things have radically changed for the better and if anything the far more economical. Vastly improved surgical techniques, certain surgeries such as those for glaucoma which are now virtually non-existent thanks to eyedrop therapy. I remember my grandmother, in the late 60’s, spending a week in the hospital for cataract surgery. Now we do a dozen before noon on an outpatient basis.
So you see EGV I don’t live in some fantasy world when things were better. I recall when we didn’t have the corruption, waste, and mismanagement of government. I recall an excellent city hospital that served those in need that was subsidized by the city taxpayers, that is when this city had taxpayers. I recall when insurance was only for catastrophic or major hospitalization and people paid the rest. Maybe in monthly installments, but they paid. You’d be surprised the folks who think they have no obligation to pay. My mother, a single working mom, could pay the family doctor and dentist out of pocket, and not declare bankruptcy. Hospitals and doctors couldn’t charge outrageous prices because they would go broke, plus there was competition. Speaking of competition EGV, you should check out our plastic surgeons where I live. Stiff competition and reasonable prices. Very few plastic procedures are paid for by insurance. You’d be amazed how people come up with the money when they want to badly enough. Not that I have a problem with it, it helps keep me in a job.
But as usual EGV nothing registers with you.
Hi Hans,
Amen again.
Hi Mary,
You’re so right. With the advances in medical technology prices should have plummeted, a la Ford’s assembly line, etc. That they haven’t reeks of bureaucracy and malfeasance.
Obamacare attacked a problem that wasn’t even priority #1, and only made it worse. Did they consult any healthcare professionals for their monstrosity?
Mary -
And this is where I find your whole response bizarre. The proper response seems to be expand medicare for everyone (single payer). I don’t know if you’ve read the Time magazine article – but folks on medicare (and in other countries) pay a fraction of the cost because of price controls and regulation. So if you want medicine lower, or procedures lower, hand it over to government control, which again has worked for medicare and other countries.
You seem to gravitate towards a solution the simply is unworkable/immoral. Let people figure out a way to pay for care, and if they can’t, and can’t find proper charity, let them die. Doesn’t that horrify you?
When faced with a system that works today – price controls and regulation, and a system that existed decades ago in which people died for lack of health care – you choose the second option. I’ll never understand that.
Hans -
We have made things significantly cheaper in many areas – for instance, polio once was very expensive, and now with drugs, it is cheaply eliminated.
But a large chunk of medicine that exists now didn’t exist then. For instance, I have a friend who was treated for cancer and she no longer has issues. If she was born in the days you folks are talking about, she’d be dead now.
EVG,
Do you have a problem with reading comprehension or just a bad memory? If I’ve told you once I’ve told you a hundred times what I see as viable alternatives to the freaking gov’t sticking its nose into our medical system and royally screwing it up, as it has with Medicare.
Where do you get the notion people were keeling over from lack of health care decades ago? Do you not recall me discussing the iron lungs and TB sanitariums? The city hospitals? Do you think only the rich got polio and TB? Only the rich broke their legs. As a toddler my sister broke her leg in a car accident and spent 6 weeks in the hospital, today she maybe would have spent a few days in the hospital then had home care. My working class parents paid the bill. How did they manage? Because the doctor and hospital had to charge according to the community’s ability to pay. Someone couldn’t try swindling the gov’t or insurance co. The doctor and hospital couldn’t charge thousands and expect to stay in business.
You trust the government to run your health care efficiently and economically?
http://obamacarewatcher.org/articles/172
http://washingtonexaminer.com/tens-of-thousands-obamacare-navigators-to-be-hired/article/2526167
BTW EGV in response to your post to Hans, cancer is nothing new. Cancer patients spent much time in the hospital, usually dying there because there was no home hospice care. I did my share of terminal care and it could drag on for weeks. Cancer surgery is decades old. My great grandmother had a radical mastectomy. She also died in the hospital. Just the surgery for the cancer itself could mean weeks in the hospital. So again, if anything, cancer patients are not as confined to the hospital as they once were, we see them more on an outpatient treatment basis. There are also palliative treatments and hospice care that enable the patient to carry on their normal lives as much as possible, or spend their remaining days in their homes.
Sounds like it should be kind of cost effective if anything, don’t you think?
Mary – It sounds like some sort of hippy plan where everyone gets what they want regardless of their ability to pay, and no skin in the game. Somebody has cancer and makes no money? Sure, the hospital will cover you – pay what you can!
Seems like the closest country I can find to that system is China – though they’ll turn people away and just let them die – so at least you aren’t advocating for that – but I still wonder who pays when somebody can’t, but demands treatment?
EGV,
What you are describing sounds a lot closer to Obamacare.
http://www.dickmorris.com/obamacare-death-panels-dick-morris-tv-lunch-alert/
I’m surprised Dick Morris hasn’t been committed to an institution yet – you get your news from him? Wow
EGV,
LOL. I get my news from various sources EGV. Also, the fact you don’t like the guy doesn’t make him wrong.
http://socialsecurityinstitute.com/blog/how-obamacare-guts-medicare