How Would You Ration Health Care?

Many countries have systems that costs 1/2 as much as the U.S. "system", and saves more lives. That needs to be the standard we use to discuss new U.S. systems. So we can reject out of hand any system that costs more than what we do now, and doesn't cover everyone.

The first thing to do is disabuse the reactionary media of their misconceptions about health care, such as, "New government programs (think Medicare) only beget bureaucracy and spending, never higher quality and lower costs." This flat-out lie appears in the Welchway column of the latest (oops) BusinessWeek.

Honest debate yes! But, how can there be an honest debate when all the special interest groups are lying to the public with half truths. In the past 30 years the people in this country have become crooks because it pays better than being honest. Did anyone on Wall St. go to jail yet?

The first thing we need to do is drop the term “health insurance”; let’s call it what it really is. It is a “medical bill payment system”. It works in a very simple manner when you cut through the crap. I give them $20 so they can pay the doctor $10 and then I pay the doctor a $5 co-pay,

I should start a business where when you pull into the gas station to fill your tank you will give me $50 so I can pay the gas station $40. And when you do not buy gas often enough I will raise your rates. When someone tries to stop my system I will call them “socialists”.

The other day I saw a Senator from Texas on the news saying that if we went through with the proposed changes to the health care system “in 15 to 20 years there would be no health insurance companies”; the problem with that would be what? He probably drives a foreign car.

One thing we could do is get the dementia patients out of nursing homes and into asylums. A nursing home is usually a skilled nursing facility, but dementia patients need custodial care. It would also give the remaining patients peace and quiet so they could recover better.

I would have it rationed via the free market, the most efficient, effective, and 'fair' option.

While most western countries have better health care as a fraction of the cost it is too late to do this now, medical and doctors fees are way to expensive and it will be doomed to be an expensive white elephant.

Via the free market..??

Ok the gov or the insurance companies for all non urgent cases send full flights overseas to places that are of good quality and a LOT cheaper. Doctors and medicine in the US are way over priced.

Though if you take the free market to the extreme most US jobs will be exported and the living standard would fall to other nations. It's worth noting many countries like China have better education systems and a lot more people, the days when only non professional jobs are exported is over. In future you will get more medical (Thailand is great for Plastic surgery), IT, accounting, legal work being exported.

First, health care is not a right, but a service that is bought and sold (regardless of what politicians claim).
Second, There is not enough health care available for everybody to have all the health care they want, because the resources available are limited, but human wants are unlimited.
Third: Therefore, rationing of health care must occur.
Fourth: The most efficient method of rationing anything is through the free market (no government involvement).
Fifth: No "socialist" (command) economy has ever created the level of wealth created by the formerly free United States.
Sixth: Government is not as efficient as the private sector in providing goods and services (think about computers).
Solution? Remove government involvement from health care.
"But people will die!" People will die anyway. The real debate is over who/what determines who will die first. Some choices include: (1) rationing through lines (queues); (2) rationing by some government bureaucrat who determines who lives and who dies; (3) rationing by prices (the "free" market). Prices are impartial and efficient. Think about any other market: computers, cars, etc. The less government involvement, the more efficient the allocation. "Fairness" is a value laden statement that is personal and cannot be agreed upon.

Fair is in the eye of the beholder. What is fair to me may not be what is fair to the share holders or the elderly or the young or... well you get it.
None of the options will cover all people and all situations. We feel we have some right to healthcare when indeed it is a product like any other. The free market system will stop the high cost of health care the same way it stops too high a cost on milk. Everyone wants it, they will continue to consume it even when expensive but will cut back enough to cause producers to cut back and the government to investigate just why is the cost of milk so darn high. Then a few years later they have to throw out milk because they can not sell it enough to cover costs. When the baby boomers age and cease to need healthcare there will be a glut of doctors and healthcare costs will have to go down for competition.
All in all I think the lowest cost option to society in the long run is let market forces do the work. You get ultimately the same result and market forces do not charge you a dime or raise the national debt.

Provide care to adults who contribute to society (employed, pays taxes, abides by laws), past contribution (retirees), those financially taken care of by others (e.g., housewives), children and legitimately disabled.

Limited or no care for able-bodied who will not work and illegals.

This might be a little simplistic but through my employer's insurance plan, I am covered up to $1500 per year in dental expenditures. That's to say that the insurance company has already anticipated reimbursing my dentist that amount for any valid expenses. That's also to say that my deductions are paying for up to this amount to be reimbursed. If I only have $500 in dental expenses for the year, I don't get any deductions back for the unused portion so why can't the remaining $1000 that I didn't use go toward someone who has no dental insurance. I already paid for it through deductions and the insurance company already had it allocated as a possible expenditure so why do they get to pocket the unused portion if I don't happen to need it that year?

Hi all, and thanks for your comments. I want to point out, to those who think denying medical care to illegal immigrants will take cost out of our health care system: The cost of treating illegals is only 1% to 2% of total health care spending. Although an estimated 15% of the nation's uninsured are illegal immigrants, most of the illegals in that group are young and relatively healthy so do not tax the health care system. For more data on this issue, go to Kaiser Health News at http://www.kaiserhealthnews.org/Daily-Reports/2009/July/09/Illegal-Immigrants.aspx

I get a little weary of the lionization of European health care, especially England's. We lived for a while in England and, trust me, the health care was nowhere near the quality we receive in the U.S. Just ask many Britons. They have essentially a two tiered system there: The National Health System and a private doctor system, the latter arising because of dissatisfaction with the NHS. If they can afford it, they told me that, without exception, they would go to their private doctor rather than their NHS doctor if they had a serious illness. Why? Because, to a person they believed they got better care. While in England, two of my university colleagues (I taught in one of the universities there) almost died due to blatant medical negligence. But there was no effective redress of their legitimate grievances in that system. Most of my colleagues openly longed for a better medical system and saw American medicine as a model.
This doesn't mean that there aren't bright spots in their medical care. Some of their specialties, such as cardiac surgery and cancer treatment procedures are excellent, primarily because they have some excellent specialists at the top end. But medicine as practiced at the local level left, to say the least, a lot to be desired. And that's where the average person experiences most medical help.
One British Minister of Parliament recently vocalized his puzzlement over why the U.S. would gravitate toward a British model of medicine when their's has proven to be so inefficient and unsustainably expensive. I wonder that too. It seems that ideology is trumping reality in the minds of politicians. And that's dangerous, especially when you consider that their cost estimates of virtually every government program they have ever devised have proven to be grossly understated. It's interesting to me that, while our politicians raged over the ineptitude and corruption of FEMA during the Katrina crisis, an agency which is, after all, a GOVERNMENT program, these same politicians now think government can do a much better and cheaper job of medical care than can the private sector. I don't think they are even aware of their own hypocrisy. Runaway ideology will do that to you!

I have 2 pensions and 35 months until my Socialist Securitization checks of ~approximately $1,314 start coming.

We own our beautiful 4,100 sq. foot home.

We will have more than $4,800 a month coming in, and no house payments.

Screw this stinking socialist country.

I have relatives living in Canada, who come to the US for treatment because they can't get the treatment they need in a timely manner. The people who have insurance through their work, will be in for a rude awakening if this passes. If you don't already have a primary doctor, good luck finding one who is taking new patients after we go OBAMA Healthcare plan. My aunt who lives in Canada needed a knee surgery, it took 6 weeks before she finally got it, which is an issue, since every morning during that 6 weeks she had to call the hospital at 5AM to see if they had her scheduled. If it passes, there will be a two tier system, us wealthy will pay for the best care, while the majority suffer with rationing of the mediocre care available.

Hello again. To those of you insisting that the US health care system is much better than those found in Canada, Britain, or other countries, beware of arguing with anecdotes. Not only has every major study found that the U.S. ranks very low on any number of measures when compared with the health care systems of other nations, but citizens in other countries are also much happier with their health care systems than we are with ours. Last year the nonpartisan Commonwealth Fund surveyed 12,000 adults in Australia, Britain, Canada, Germany, the Netherlands, New Zealand, and the U.S. The results: One-third of Americans believe the U.S. health-care system needs to be rebuilt completely--double the percentage of those who want a dramatic overhaul in the six other nations polled. The U.S. ranked dead last out of the seven countries when residents were asked if only minor changes were needed.

The U.S. is also as bad or worse than other nations when it comes to wait times. Another study by the Commonwealth Fund of sicker adults in six industrialized countries found that only Canada was worse than the U.S. when it came to waiting six days or longer to schedule a doctor's appointment for a medical problem. The Commonwealth survey did find one area in which the U.S. took first place: 51% of U.S. adults surveyed did not visit a doctor, get a needed test, or fill a prescription because of cost. No other country came close to that percentage. That, readers, is rationing.

At any rate, this argument is moot because both Congress and President Obama have repeated over and over that they have no interest in ending the current employer-based insurance system and switching to a single payer system such as is found in Canada and Britain. There is no legislation under consideration that even comes close to such a change.

If you would like to read the stories I did on the two surveys named, for citizen attitudes go to: http://www.businessweek.com/print/magazine/content/07_46/b4058055.htm?chan=gl

and for wait times: http://www.businessweek.com/technology/content/jun2007/tc20070621_716260_page_2.htm

I have worked in the health care system for for profit hospitals and not for profit hospitals...and at both, a wallet biopsy is done prior to anything other than basic life support. It is a cruel fact that has gone on too long.

There needs to be a basic coverage for all Americans. All should be required to contribute if they choose to be covered by it. Whether it is a dollar a month or $400...it should be on a sliding scale.

If one wishes more coverage than the basic coverage offered by the government then one could purchase a policy from the private insurance companies.

The insurance companies are not our friends...they suck you dry on payday and complain if you use their services. I pay through the nose for the care that my husband primarily receives. I try to stay as far away as possible from the doctor's office...I have seen what they can do.

Yes, basic coverage for all is going to be expensive, but it is far more expensive now...saving someone from near death is a lot more costly than preventative medicine.

Most expense is racked up in the last year of life. There should be a movement limiting the amount of time that an elderly patient should be allowed to languish on a ventilator with a diprivan drip going and dialysis every other day. Many families selfishly keep the "loved" one alive to keep collecting the social security checks. In fact, several of the patients I cared for today are in exactly that predicament. they are not cognizant of the world around them at all...they are in limbo. Meanwhile, the "loving" relatives continue to suck the system dry. Don't think it doesn't happen, it does...more often than one can imagine and it is horrifying.

Once the boomers have died off...and we will faster than the current generation as we will be the ones where the rationing really occurs. limit the amount of health care for someone over 75...spend the money on the future of our nation, the children. They need the help more. there is a finite amount of dollars...get used to it. Those of us over 60 had better get used to that fact. We don't deserve everything we want at the taxpayer expense, but our children do.

What I would like is for it to remain my choice, not the choice of a bureaucrat. I had an uncle in Canada who had cancer for three years before his doctors even told him. They wouldn't treat him in Canada because, despite his overall health, he was too old. He came to the United States for care that he could pay for out of pocket (that is illegal in most parts of Canada) but unfortunately died anyway due to the 3 year wait. His cancer had progressed too much. Socialized medicine is a fancy word for health rationing. There are better ways than giving the government control to fix our health care system so that everyone has access.

Your solution doesn't address the issue it just hides the cost. Why does medical care cost so much? Because like taxes, for most of us, we are disconnected from the transaction. Someone else writes the check. The bulk of of the money comes out of a checking account we don't see or have to balance. You want government health care go to a VA Hospital, talk to people who are on many of the other government, state or federal, health care programs. No matter how well intentioned the progenitors of these programs are they will not live or control these programs forever. Tell me of a government program that ever stayed within projected cost. From 1946-66 medical cost stayed even with inflation. From 1966 medical have gradually accelerated above the rate inflation till we reached the situation we are in. What happen in 1966? The actual implementation of the first of the "Great Society" programs. If you follow the ever increasing government involvement in health care you see ever escalating cost.

I, too, lived in England, and found most of my friends hated the medical system. Care was rationed by 'wait time' as well as money. The patient suffered while he waited, often for years. I've read those surveys and polls--the results depend on how the question is framed. 90% of people will say they hate Santa Claus if the question is properly asked! I'm for letting the free market do the rationing in this country.

Any rational cost reduction system looks first at what the large costs are. It is my understanding that roughly 1/3 of a medical practice budget is spent on malpractice insurance. This screams for reform, but since our legislators are predominantly lawyers, it does not get discussed, let alone fixed. We already ration health coverage for those that are properly insured. In my case, Medicare will only pay for a PSA test once every 12 months. If my doctor's appointment is as much as one day before that 12 month deadline, I must go back to the lab later to have it done. One of the ways we limit medical coverage is to refuse annual physicals for the not visibly sick. Fortunately, my health coverage (retired military) does pay for these visits. This has saved my life twice. First when I had colon cancer at 60, and this was discovered at my annual physical, even though I had no clue that anything was amiss. The early detection resulted in complete cure. Recently, I was diagnosed with CLL, the "good" form of Leukemia. I am under treatment for that now, with every expectation that I will be OK because it was picked up early. (You are never cured of CLL, but it can be knocked into remission whenever it goes active, if it is caught in time.)

I CAN'T BELIEVE WHAT I READ, WORKING
IN THE MEDICAL FIELD FOR 40 YEARS AND
GENERAL PRACTICE............ HOW CAN
ANYONE DEAL WITH A HMO??? WE REFER
PEOPLE AND IT TAKES 4 MONTHS TO GET
A OKEY FOR TREATMENT- YOU GET WHAT
YOU PAY FOR AND MOST OF YOU OVIOUSLY
HAVE NEVER PAID FOR IT..............
WE PAID TO HAVE BABIES AND GO TO THE
PEDIATRICIAN ETC, GET OVER THE FREE DAYS
AND MOVE ON. I PAY FOR MY OWN INSURANCE AND ALWAYS HAVE, CAN GO ANYWHERE IN THE UNITED STATES FOR TREATMENT AND GET THE BEST CARE, NO REFERRALS OR HMO'S FOR ME...........MOST OF YOU EXPECT HEALTH INSURANCE FOR ALL YOUR DRUGS................AND I AM NOT TALKINT ABOUT THE OLDER , THE YOUNG ARE SO IN TO MEDS AND MORE MEDS AND MORE MEDS..................

I lived many working years in Austria and Switzerland, but I must agree, the US has the worst medical system. I pay $1025.00 a months and going up every year.And guess who is paying most of the money to medical bills. Medicare. HMO just collect, but no return. If they are not crooks, I dont know, who is

The government doesn't seem to have a problem passing laws telling the credit card industry what to do, so why can't they do the same for the insurance industry. One of the reasons cost is so high is because of malpractice suits. These suits cause the doctor's and hospital's insurance premiums to go up so they have to raise their prices to pay for it which in turn gets passed on to the consumer's insurance co who then raises their premiums. Let the government put a cap on lawsuit payouts and standardize the prices of medical procedures and then pass a law requiring the insurance co to offer insurance to everyone at a reasonable cost. Make it like car insurance which has a government required minimum coverage.But definitely the government should not be going into the health insurance business. They can't adequately handle the tax money they get now, why should we think they'll do better later?

Free market forces did such a fantastic job on the housing market. Do you really want a "no government oversight" situation in health care? Oh, wait a minute, that's pretty much what we have.

Why not fund preventative measures? Discount your premiums based on percnetage ideal body weight, losing weight, reducing blood pressues or blood glucose. Give the consumer the cash (doesn't need to be much) for easily quantifiable results.

Hi all--I'd like to respond to T.E Darby and Stacie and their widely-held view that expensive malpractice insurance, along with large awards to patients, is a major factor behind the high cost of U.S. health care. Both medical malpractice awards and premiums have accounted for well under 1% of total health care costs for the last 20 years. The average malpractice award is $350,000, not the millions of dollars many people assume. Then there is the argument that the fear of being sued causes doctors to overtreat, thus raising health care costs. This issue has been studied many times; a comprehensive analysis of the results by the Congressional Budget Office in 2006 concluded that "In short, the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency.” You can find the CBO study at http://www.cbo.gov/doc.cfm?index=4968&type=0

We don't have to ration health care. All that needs to happen is for our president, vice president, house and senate to be covered by the identical system that we get. What's good for the goose is good for the gander.

I work in a hospital setting after 20 years in fee for service practice. I am realistic about the need for rationing but have great difficulty with what has been proposed thus far.
1) Abritrary age cutoffs. We all know 80 years olds that can run circles around the 40 year olds on their block, staying active while the younger folk are couch potatoes contributing to the obesity epidemic. The 80 years old's permformance status is better that that of the 40 year old and she would like do better and be more motivated to get over any procedure.
2) On the other hand we have the 80% medicare hemorrhage in the last months of life. This is a protracted and often miserable way to die. Some of you had said that doctors and medical personnel failed to acknowledge advanced directives. That is a time for complaint to the hospital board if they are truly ignoring a wirtten doecument.
In my hospital, such situations are usually family driven, "we have to do everything we can for momma". This is regardless of the futility of the care. We had one woman whose 9 children insisted on aggressive rather that comfort measures even though Mom was rotting from the inside out (failure to heal following exploratory Lap; bascially oozing from multiple sites in intestons) and took 8 miserable months to die. We had huge family and multidisciplinary meetings to no aviail.
3) Families in these sitiatuions including a recent 60ish persistive vegetative state following out of hospital caridiac arrest: Mom is trached and pegged; has no meaningful interaction. She has been institutionalized at government expense since this happened 4 months ago. Daughter will be taking her home with hospice but will also be bringing her back with any problems as she is a full code. This is futile care. Currently the daughter simply tells us,"you have to do what I tell you to do" "I have a lawyer".
4) In my opion the system could save millions, if not more, every year by revoving the spector of malpractice from refusal to participate in futile care. Regardless of the age of the patient.
5) The other huge group that become frequent fliers in our hospital systems are those who have an inadequate medical home. The self pay or underinsured patient who has difficuly getting into an MD office because he owes a bill and hasn't made an effort to work it out. We see sicklers return to the hospital because they run out of their narcotics, we see diabetics return in DKA because they don't have medical home and are incapable of making needed changes in life style for diabetes without that support. We see heart failure patients return time and time again due to inability to make necessary outpatient adjustments to keep them out of the hospital. And, over and over, we see people return because they fail to get prescriptions even after we make an effort to select four dollar co pay prescriptions or even free antibiotics at a local grocery store chain. A functional medical home could monitor those issues and prevent unneccesary repeat hospitalizations which are a very expensive way to obtain care. I sure hope they are getting information from those in the trenches about where many of the real breakdowns occur. I have not seen much of that at all in the language that has come out of DC.

I agree with Roselyn Lewis. If the goverenment run health care system is so good why is the President, Congressmen,Senators and their families exempt from it? Something to think about.

The author, back again. In response to Roselyn Lewis and Sonny: The fact is, the President, Senators and Congressmen do get the same system as those of us who have top-quality insurance coverage. They are covered by a comprehensive insurance policy paid for by the federal government (the president is also treated by government doctors). The only truly government-run health care systems in the US are Medicare (because the federal government pays for all health care provided seniors under the system) and the Veteran's Administration (where doctors actually work for the federal government). Medicare consistently gets much higher satisfaction ratings from its users than private insurance, and surprising as this may seem to many of you, the VA health care system rates much higher than private hospitals on virtually every measure, including patient satisfaction. For more on the VA, read my story "The Best Medical Care In The US," http://www.businessweek.com/magazine/content/06_29/b3993061.htm

Health care reform is so complex an issue that a majority of the House of Representatives feel they don't have time to even read the bill they hope to enact, that should be an indication as to one of the major problems. Someone once said when eating an elephant it's best to start with one bite at a time. Restricting or rationing health care shouldn't be the first step. Administrative and Tort reforms are needed. A rough rule-of-thumb for determining where health care dollars go is a third to physicians and providers, a third to institutions (hospitals, etc.) and a third to insurance companies who maintain the policies. The next step is to look at how each of those "thirds" handle the cost of doing business. Physicians and other providers pay huge sums to carry malpractice insurance, even going so far as having to arrange personal finances to protect private assets. Hospitals spend inordinate amounts of money on "protective" practices as well as liability insurance. No one wants to know how much insurance companies lose to fraud claims each year. Improving administrative practices (claim forms, means and methods of billing, enforcement of existing rules and regulation) would reduce health care costs by billions. Tort reform which is the "third rail" of health reform would lower costs, but would more importantly lower the adversary roles between hospitals, physicians, and patients. Then we would have a starting point for an honest an open discussion for health care reform. Until the Congress does it's job any attempt at health care reform will be more taking from one group to give to another then an honest attempt of improving the system. As an editorial comment: The Health Care system is not broken, it works just fine. Yes we can do better at lowering costs and improving care. But the proof is in the pudding; we are living longer than we anticipated, hence the cost of taking care of ourselves will continue to climb. Of course we could drag out Gov. Dick Lamm and make it a patriotic duty for the old to "die off".

Cathy,
The difference is the that President, Senators and Congressman don't have to pay into the system after they leave office. They can receive the best health care for free the rest of their lives!

The main point of your 'rationing' is rhetorical. Everything is rationed whether we can control it or not: example are sunlight, time, locations. As long as the items we need or want are in scarce supply, there will exist a cost and a price to obtain such items.

Let's talk costs. You and the President talk about the costs of healthcare. What specific costs are you referring to: my co-pay, my monthly premium I pay vs what my company pays, my prescriptions, or what?

Stacie is correct that lawsuits, or more indirectly the avoidance of a lawsuit, is something every doctor considers when prescribing treatment. That info is never tracked but if you talk with enough doctors (I have discussed this with over 300 doctors) you would find that unnecessary lab work, x-rays, MRI's, etc, are ordered to avoid lawsuits.

Cathy, enough with quoting studies. Cathy, get out there and do some leg work--interview a broad section of doctors, nurse and administrative staff from hospitals, clinics, and health care companies.

Our President and Congress are discovering that it is impossible to cover the alleged 40+ million uninsured. Nothing is free in this world and there is a cost and price for everything.

And no, there will not be a greater cost by doing nothing. You can't save money by spending it.

I fully agree with Lou about end of life care. I work in a long term acute hospital. Of the 30 or so patients on my floor only 3 are DNR's. We have 80 plus patients on vents, dialysis, and tube feedings. We (the nurses) all know that these patients' chances of ever leaving the hospital to go home are very very small, but the families are insistent that everything be done. So, these poor people go back and forth frome acute care hospital to ours, before finally dying months later. Think about this...do you really want your elderly parents to spend months on a vent, fighting one infection after another before finally dying? Plus, our doctors are not very good at bringing up end of life care. And the hospital I work for is for-profit. When I first became a nurse 30 years ago, we did not put elderly patients on vents for months.

For one, we need medical reform that takes medical care out of the arena of private investment companies, including the payment of huge salaries and bonuses to employees and officers of the corporation. Since almost none of the companies actually pay dividends to the stock investors/speculators ending the ability of these companies to trade publicly would have little effect on overall market dynamics. Next, the insurance/health care industry should be forced by law to seek judicial review before they eliminate or limit coverage to any of the insured. this shifts the presumption in favor of treatment and raises the stakes and legal costs to the insurance company if they want to quit their obligations (additionally it relieves the ill and their families of the emotional and legal expense of suing to get the insurance to do what they by contract are required to do). Last, any person with a serious and likely terminal illness should, by law, be given a quality of life course taught by medical personnel outside the treatment facility, so they can be educated to the facts and options. Finally, only as an issue of social awareness, we all need to understand that death is inevitable and to let go and love ourselves and others enough to not drag them through endless and hopeless medical procedures that prolong suffering and take away human dignity only to satiate our selfishness. Love is not watching mom dissolve on a death bed for months and maybe years.
I am not sorry if this offends you.

I work in the healthcare system. I just invested 8 years and am $300,000 in debt to become a primary care physician. Personally, I wish I never would have gone into medicine.
- The way that Medicare "cuts cost" is simply to pay us less. In a hospital, we are reimbursed approx 70% from insurance, but only 22% from Medicare/Medicaid. If this continues I will refuse to see Medicare/Medicaid patients because I ALWAYS LOSE MONEY. 2.If I have to see another "poor" Medicaid person who walks in wearing 60 dollar sneakers, driving an SUV I'm going to scream. 3. I 100% support a "fat tax". If people are obese smoke and cause most of the healthcare costs they should have to pay more. 4. Cut back on end-of-life care to the elderly-its ridiculous to spend tens of thousands on someone who is in a coma

Why isn't anyone talking about the hidden costs of health care? When my husband opened his office 30 years ago, he had an employee and one part time employee. Blue Cross Blue shield suggested he RAISE his fees and become a preferred provider!!! To cover overhead, he needed to do 5 endoscopies a week. Now we have 4 doc's with about 30 employees to file insurance and now requires EACH to do about 7 endoscopies/day to cover the overhead, or the costs of doing business!!!

Our current heath care system is not a perfect paradigm, however lets not rush to throw the baby out with the bath water!

The most vulnerable in a society that is civilized should receive compassionate care that leads to quality life and what that means MUST be a decision made between that person, their family and their doctor, NOT by our government. Furthermore, a government that is of and for the people should be just as it says it is and help those who cannot pay for it themselves. In addition, hospitals, doctors and other health care providers need to have standards for which they are held accountable, yet they must not be taken advantage of by the insurance companies. Tort reform is necessary as lawyers are dipping in at our expense as well!

Many citizens are able pay for day to day health care needs and can pay reasonable insurance premiums to cover their costs. Why shouldn't companies use health care benefits as a means to attract a better more loyal employee?

What I keep wondering about is the silence about how much money the insurance companies continue to make. They seem to be making millions every year in profit. Maybe they need reform and regulation. Refusing to insure people with pre-existing conditions, raising premiums on the ill, demanding unreasonable rates from health care providers and they come out smelling like a rose?

Isn't anyone questioning them! They are a major player in this mess. Should they return a portion of those premiums paid where no claims have been made to help fund Medicare and Medicaid, instead of realizing such unbelievable profit on their investments. Or, could their lobbies be so strong that the entire nation falls due to their abominable greed. Enough is enough.

And, lets cut some of the bs funding that goes to research the testi fly or funding "politician joe's" favorite building project. The government is taking the easy way out. They need to do more WORK on this and not ram this crazy legislation down our throats.

Don't give them a break. You may not only pay with your money, but your life, or that of your love ones!

I agree with Denisse + Katie ,

I worked for 28 years as a ICU nurse . When I first graduated 28 years ago , We did not keep comatose folks on vents for months .I have severe heart disease after being insulin diabetic since age 6 . I was "coded " by my co-workers when I collapsed at work in ICU . Note, I am thin, never smoked, no fast foods. I only lived this long as I HAVE taken good care of myself. I have a LiVING WILL that states "DO NOT INTUBATE" I have been close twice + stand Steadfast to this. Keeping DEAD folks alive when they've lost cerebral funtioning is LUDICROUS! Lin , RN

This is what I think, Take away the Senators and Congressman's government health-care and the retirement benefits that they will receive, and you will see how fast changes will be made to health-care and the social security system.

Instead of healthcare reform, let's do insurance reform. Let Doctors get paid properly and put caps on what can be charged. Get more generalized Doctors trained. I want to go to one Doctor for all my aches and pains.

Cathy, I'm sorry to hear of your painful losses. It sounds like no one had discussed goals of care with your family. Many in the health care field are uncomfortable discussing goals of care and instead offer only aggressive treatment. Families often mistake all of the shiny equipment and aggressive treatment ("They're doing EVERYTHING for her")as physical, tangible evidence of their love. Also, they often aren't aware that they can refuse any treatment they don't want.

Had my family not REQUESTED hospice care for my Grandma, she would have received a feeding tube and a battery of expensive tests. She was 88 years old, lived in a nursing home due to severe dementia and was combative with the staff. Needless to say, a feeding tube would not have fixed her problems. We learned through hospice that the decreased appetite was part of the natural dying process. Instead of the tube, she was allowed to eat whatever she wanted and if she didn't feel like eating anything, that was alright, too. Her treatment and care became simply whatever made her comfortable and happy. This type of care was never offered, the family had to request it. We also had to request a Do Not Resuccitate(sp?) order in the hospital; the subject was never brought up by hospital staff. How they thought that CPR would have been in Gramma's best interest is beyond logic--and compassion.

People need to stop for a moment and think about your goals of care before you get put throught the merry-go-round of the health care system.

We were given a book called Hard Choices for Loving People. I don't know where you would get a copy (your local hospice?) but it is excellent.

I guess the take away message from this is that you DO HAVE CHOICES when it comes to your healthcare. If more people knew this, we wouldn't have so many of our elderly dying miserable deaths, trached and pegged in the ICU in the name of love.

Well while this is an amusing article it does leave out the facts that there is limited resources, limited doctors, and limited hospitals and so on. The ACLU could not be happier to have the USA taxpayer’s fork out for the entire world to come here and get free health care. Most voting Americans know no limits and the free market keeps us in check. Without free market rationing the US would have 3rd world health care much like California’s education system and all the doctors will have the same name Raja. We will import doctors and medical staff because they cost to much. They will then unionize and then cost to much, and the tax payer will lose again.