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  #51  
Old 08-12-2019, 01:28 PM
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IANAD, but there is a discussion of why generic insulin isn't widely available here.

Also, there is a "regulatory dead zone" where if you submit an application and it isn't approved before next March 23, 2020, it will be automatically rejected. And the pharma companies can't use any currently approved forms of insulin to show that the new generic form is safe and effective until after that.

It's complicated, and an example of how regulations don't always do what is intended, even when those intentions are good. And also not necessarily "big pharma is evil price-gougers cackling insanely while their customers die while they wring a few more dollars out of sick old people".

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  #52  
Old 08-13-2019, 09:34 AM
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LaLa land


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What kind of LaLa land do you live in, where everyone who needs help gets it?
Canada and various European countries spring to mind.
  #53  
Old 08-13-2019, 10:51 AM
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Unfortunately its a complicated system and hard to navigate alone.
That is an understatement. On a different aspect of how you can get fucked by the U.S. healthcare system, I posted what happened to me a couple of years ago, see here:

http://boards.straightdope.com/sdmb/...6&postcount=14

I have the best insurance available to me (an ACA-compliant plan). But for many weeks I thought maybe I was on the hook for about $200,000 for emergency surgery out of state. My insurance company deliberately misled me, and I ultimately had to do my own legal research. I'm lucky that it turns out the law is on my side in New Mexico, whereas in many states I would have had no clear legal protection. And I had to figure out all of this on my own while convalescing from major surgery - there's no help navigating the arcane financial aspects of the US healthcare system, even if you can afford to pay a lawyer. I'm privileged to be well educated, English is my first language, I have financial resources and I'm assertive. But even for me this was a extremely stressful nightmare over an amount of money that could lead someone to bankruptcy and even suicide. Imagine how things are for an elderly person, a busy working single parent, someone who doesn't speak fluent English?

Last edited by Riemann; 08-13-2019 at 10:53 AM.
  #54  
Old 08-13-2019, 10:52 AM
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Of course, there are all kinds of problems with the for-profit healthcare industry, which should be addressed.

But I believe SOME sort of rationing is necessary. I did not see in the story what the medical conditions/expenses were. Mid-70s isn't ancient, but it isn't young either. Some cost/benefit analysis of what expense for how many quality years is appropriate. If you are old enough and sick enough, IMO you ought to be provided palliative care - and options for assisted suicide.
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  #55  
Old 08-13-2019, 11:05 AM
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But I believe SOME sort of rationing is necessary. I did not see in the story what the medical conditions/expenses were. Mid-70s isn't ancient, but it isn't young either. Some cost/benefit analysis of what expense for how many quality years is appropriate. If you are old enough and sick enough, IMO you ought to be provided palliative care - and options for assisted suicide.
Maybe there could be some sort of "Logan's Run" option. You get premium healthcare for X amount of time and then, blink, lights out. They could even automate it with an implant which was programmed to automatically release a fatal sedative while you were sleeping at the appropriate time.

Personally, I would love something like that should I get a debilitating condition like dementia. It would be great while I still had some of my capabilities to say "I want one more year to slide away and then that's it for me."
  #56  
Old 08-13-2019, 11:11 AM
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Of course, there are all kinds of problems with the for-profit healthcare industry, which should be addressed.

But I believe SOME sort of rationing is necessary...
But I think it's pretty offensive to even have a conversation about the need for "rationing" until the clusterfuck that is the U.S. healthcare system is fundamentally reformed in line with civilized modern human values and sensible economic principles. Until we at least try to take a fundamentally sensible approach to providing universal healthcare in an efficient manner, I think it's immoral to be talking about trying to save a few dollars here and there by letting some elderly people die.
  #57  
Old 08-13-2019, 11:14 AM
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Of course, there are all kinds of problems with the for-profit healthcare industry, which should be addressed.

But I believe SOME sort of rationing is necessary. I did not see in the story what the medical conditions/expenses were. Mid-70s isn't ancient, but it isn't young either. Some cost/benefit analysis of what expense for how many quality years is appropriate. If you are old enough and sick enough, IMO you ought to be provided palliative care - and options for assisted suicide.
That's not on. If your doctor concludes that your advanced brain cancer is untreatable, that's one thing, but not as a "cost/benefit analysis", except in sci-fi dystopias and incisive satire.
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Old 08-13-2019, 11:34 AM
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Of course, there are all kinds of problems with the for-profit healthcare industry, which should be addressed.

But I believe SOME sort of rationing is necessary. I did not see in the story what the medical conditions/expenses were. Mid-70s isn't ancient, but it isn't young either. Some cost/benefit analysis of what expense for how many quality years is appropriate. If you are old enough and sick enough, IMO you ought to be provided palliative care - and options for assisted suicide.
So...death panels?
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  #59  
Old 08-13-2019, 11:40 AM
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Fine. People may disagree. (And get offended.) Just stating my opinion.

I'm in favor of GREATLY expanded public healthcare, and DRASTIC revisions of the for-profit healthcare industry. But I do not support UNLIMITED free health care for EVERY person.

I imagine we might be able to identify some ridiculous outlier of an example that most of us would agree on. An extremely aged person with very poor quality of life, whose life could be extended some short period through some very expensive procedure. Should that procedure be publicly subsidized? If you agree not, then we simply need to see where YOU would draw the line.
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  #60  
Old 08-13-2019, 11:46 AM
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So...death panels?
By this misleading negative characterization, every healthcare system anywhere that makes any choice about where best to devote resources is a "death panel". The only way to avoid "death panels" is to have no healthcare at all, then everyone gets exactly equal resources.

And the current U.S. healthcare system is the worst "death panel" of them all, in allocating a vast proportion of available resources to inefficiency and corporate profits instead of actual healthcare.
  #61  
Old 08-13-2019, 11:50 AM
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Fine. People may disagree. (And get offended.) Just stating my opinion...
I don't disagree with the principle of allocating resources sensibly, of course that's true. It's just a question of addressing problems in the order of importance, in both an economic and ethical sense.
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Old 08-13-2019, 11:52 AM
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In any medical system - capitalist, UHC and every other variant - there are "cost/benefit analyses" going on. Resources are always limited, and sometimes those that are unfortunate enough to be outliers draw the short straw. Even on the NHS, which does a pretty good job of prioritizing both by individual medical necessity and to achieve the best overall outcomes, occasionally gets cases where individuals suffer from conditions that can only be addressed by treatments that are excessively expensive (like in the hundreds of thousands of pounds), highly speculative, or both, and the NHS has to draw a line there. And while they don't automatically and cavalierly write off the elderly, if you're 87 and need a liver transplant you're probably not going to be as high on the recipient list as a 37-year-old needing a new liver.

There's no perfect system. But the US system is really fucking flawed.

Last edited by Gyrate; 08-13-2019 at 11:52 AM.
  #63  
Old 08-13-2019, 11:55 AM
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That is an understatement. On a different aspect of how you can get fucked by the U.S. healthcare system, I posted what happened to me a couple of years ago, see here:

http://boards.straightdope.com/sdmb/...6&postcount=14

I have the best insurance available to me (an ACA-compliant plan). But for many weeks I thought maybe I was on the hook for about $200,000 for emergency surgery out of state. My insurance company deliberately misled me, and I ultimately had to do my own legal research. I'm lucky that it turns out the law is on my side in New Mexico, whereas in many states I would have had no clear legal protection. And I had to figure out all of this on my own while convalescing from major surgery - there's no help navigating the arcane financial aspects of the US healthcare system, even if you can afford to pay a lawyer. I'm privileged to be well educated, English is my first language, I have financial resources and I'm assertive. But even for me this was a extremely stressful nightmare over an amount of money that could lead someone to bankruptcy and even suicide. Imagine how things are for an elderly person, a busy working single parent, someone who doesn't speak fluent English?
Yeah and the under 65 medical system is especially messed up. Medicare does work better than that.
  #64  
Old 08-13-2019, 12:30 PM
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I think there is more of this going on than is talked about because not everyone leaves a note explaining the medical expense conundrum. Our legislature can put a stop to it. Disgusted that they won't.
  #65  
Old 08-13-2019, 12:39 PM
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Our legislature can put a stop to it.
I've written to Susan DelBene (D-WA, my representative).
  #66  
Old 08-13-2019, 12:44 PM
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I've written to Susan DelBene (D-WA, my representative).
Awesome. More of this, everyone.
  #67  
Old 08-13-2019, 02:14 PM
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Fine. People may disagree. (And get offended.) Just stating my opinion.

I'm in favor of GREATLY expanded public healthcare, and DRASTIC revisions of the for-profit healthcare industry. But I do not support UNLIMITED free health care for EVERY person.

I imagine we might be able to identify some ridiculous outlier of an example that most of us would agree on. An extremely aged person with very poor quality of life, whose life could be extended some short period through some very expensive procedure. Should that procedure be publicly subsidized? If you agree not, then we simply need to see where YOU would draw the line.
Lots of people agree. My mother's doctor has talked to her about the possibility of getting a kidney transplant if her kidney disease progresses. And she said, "no, that's a bad use of resources. I'm old and have other health issues. It's not responsible to expend that sort of resource on me."

I don't know how common that sentiment is among people who are actually looking death in the eye.
  #68  
Old 08-13-2019, 05:33 PM
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Lots of people agree. My mother's doctor has talked to her about the possibility of getting a kidney transplant if her kidney disease progresses. And she said, "no, that's a bad use of resources. I'm old and have other health issues. It's not responsible to expend that sort of resource on me."

I don't know how common that sentiment is among people who are actually looking death in the eye.
Not knowing your mother or her situation, she may actually be making the right decision for her. Most laypeople do not realize that a huge percentage of organ transplant recipients remain chronically ill, just in a different way than they were before.

My aunt, who had a genetic kidney disease that she passed on to her son (IDK what it's called) was briefly on the transplant list at about age 70, and taken off because it was determined that her overall health had deteriorated beyond a point where she would have benefited from a transplant. My cousin did receive a transplant from my uncle about 10 years ago, and in the meantime developed a type of lymphoma that only occurs in immune-suppressed people, and his doctors have already told him that there's a very real possibility that his 80-year-old kidney will fail in the coming years, and he will need to be re-transplanted.

As for insulin, I'll never forget the first time I rang it up. I was a 16-year-old Target cashier in 1980, and thought there had to be some kind of mistake because there was just no way something this important could cost $6.28. It would have been the old animal-sourced insulin (beef or pork; fish insulin has also been used in Asia) and even though I was years away from deciding I wanted to be a pharmacist, I did know what it was. More recently, ca. 2000, when I worked at the grocery store, Humulin was about $20 a vial, and when people paid cash, we charged cost plus $1. (This was most commonly done by people who were buying it for their pets.)

When I heard of Humulin, I asked if they took pancreases out of dead people and extracted the insulin (I knew they used to do that with pituitary glands and growth hormone) and was told no, that a gene for human insulin was inserted into a special strain of E. coli bacteria, which then cranked out as much as they needed.

Animal insulins were phased out in the U.S. in the 1990s, much to the chagrin of many diabetics who had used it without issues for decades.

Last edited by nearwildheaven; 08-13-2019 at 05:34 PM. Reason: genetic, not generic
  #69  
Old 08-14-2019, 01:56 AM
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When I heard of Humulin, I asked if they took pancreases out of dead people and extracted the insulin (I knew they used to do that with pituitary glands and growth hormone) and was told no, that a gene for human insulin was inserted into a special strain of E. coli bacteria, which then cranked out as much as they needed.
If that's the case, Humulin should be dirt cheap. Believe me, it's not.
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Old 08-14-2019, 02:06 AM
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The health insurance system is obviously terrible, but I'm a little dismayed at the degree to which I've seen this portrayed in the media as a healthcare issue rather than an inexcusable violent crime. This woman died because she was a victim of domestic violence.
In Spain a few years ago the figure of "domestic violence" was removed from the books and replaced by "gender violence". There is currently a case in the courts* where a man who had just been diagnosed with dementia and who cared for his demented wife and her demented parents killed all four: the gender-violence courts want the case, the government's attorney says it shouldn't be called gender-violence, since gender is clearly not any kind of root cause of it (it's not "I killed her cos she was mine"). That a murder happened in the house doesn't necessarily qualify it as domestic or, using the current Spanish parlance, that it was a man on a woman as gender-triggered (never mind that the gender court is forgetting about the in-laws completely: what, they were flowerpots?).



* That probably nobody will ever be tried doesn't mean there is no need to investigate. One of the main purposes of these judicial investigations is to figure out what went wrong, what failed, so that preventive measures can be put in place. For cases like this, what should be put in place: a better social safety network for ill people, or violence-prevention education?
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Last edited by Nava; 08-14-2019 at 02:09 AM.
  #71  
Old 08-14-2019, 04:52 AM
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Of course, there are all kinds of problems with the for-profit healthcare industry, which should be addressed.

But I believe SOME sort of rationing is necessary. I did not see in the story what the medical conditions/expenses were. Mid-70s isn't ancient, but it isn't young either. Some cost/benefit analysis of what expense for how many quality years is appropriate. If you are old enough and sick enough, IMO you ought to be provided palliative care - and options for assisted suicide.
In what world is mid-70s not ancient?

The rest of what you say is how medical care works in any healthcare system. There isn't endless money. But in most of the developed world that means saying - in very, very toned down words - "I'm sorry, you're 75 and chemo would make your remaining years terrible while costing the health service lots of money." Not "no insulin for you, povo!"

In the UK, if someone in their 70s killed their partner and themselves, citing medical bills, it would be a straightforward case of murder-suicide because there wouldn't be any medical bills.
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Old 08-14-2019, 08:09 AM
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...

I don't know how common that sentiment is among people who are actually looking death in the eye.
I don't know either. I sure hear much more frequently of ridiculous amounts of care being provided to someone who is already quite decrepit and dies soon despite the care provided.

You and your mom have way too much on your minds for my opinion to matter to you, but I want you to know that her attitude impresses the hell out of me.

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In what world is mid-70s not ancient?
I was trying to appear reasonable, by suggesting I was only speaking of REALLY old people. My personal thought is that if you make it to your mid-70s in somewhat decent health, you've had a pretty good run.

Today, I think average life expectancy in US/Caanada/England is around 78-82 years. But if you have made it to 60, I believe it is well into the 80s. When my parents died at 76 and 78, I felt they died too young. My MIL made it to her mid-80s, and FIL is 90 (too damned mean to die!)
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  #73  
Old 08-14-2019, 08:35 AM
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It's complicated, and an example of how regulations don't always do what is intended, even when those intentions are good. And also not necessarily "big pharma is evil price-gougers cackling insanely while their customers die while they wring a few more dollars out of sick old people".

Regards,
Shodan
Another prime example of this was the law that insurers had to spend 80% ( or was it 85%) of what they collected in premiums towards actual healthcare expenses.

This law lead to increased prices across the industry. Because it turns out that the insurers don’t have a lot of incentive to haggle with their suppliers if they don’t get to keep their savings.

And while I am HIGHLY critical of the pharmaceutical industry, it don’t think they are evil price gougers cackling insanely while killing people. (And I don’t call them Big Pharma). And I think dismissing legitimate criticism as a liberal meme only serves to make the situation worse. It’s denial of a real and serious set of problems.

They are a business. They are doing what businesses do. They are developing products and trying to get those products consumed by as many people as possible. They are developing pricing and marketing strategies to make as much money off these products as possible. They are lobbying for laws that will make it easier for them to accomplish these goals

Even though I’m liberal, I’m a capitalist and a successful business owner. I generally believe in these principles. But the biggest problem here is that the products aren’t iPhones, they include powerful psychiatric medications and highly addictive drugs with serious side effects. And the constant push to expand the customer base for these products has the potential to cause great personal and societal harm.

(There are other problems with the industry such as the widespread use and acceptance of surrogate endpoints leading to drugs that reduce a “number” or shrink a tumor without providing any evidence that the drug action confers a benefit to survival or quality of life, but that’s for another discussion.)


And when you combine the pharmaceutical industry with the insurance based healthcare system, you end up with a massive free market distortion where there is no force applying any downward pressures on pricing.

The patients, if insured, are paying a flat rate per month and have little incentive to be cost conscious regarding individual items. And any attempt to control costs by the entity that’s actually paying the bill makes them the bad guy.

For example, many insurance companies require that patients try a 30 day course of an older cheaper drug before they will pay for an ultra-expensive version that is virtually identical except for a few insignificant molecular tweaks. Now I think this is a perfectly reasonable policy in most cases. And I bet that any patient forced to make a rational economic decision between a drug that costs $30 a month and a drug that costs $3000 a month would agree to that condition if they were paying the bill themselves.

But this policy is wildly vilified.

Several years ago, 3 doctors at Sloan-Kettering refused to add a drug to their formulary because they did not feel the benefits it conferred were worth the outrageous financial cost. This was a bold move that I truly hoped would catch on, but unfortunately it didn’t. I think they did succeed in getting the prices lowered for that particular drug that one time, though.

The medical industry has conditioned us well. We are taught to demand the best and most expensive treatments for even the most minor conditions. And if you don’t think anything is wrong with you, there will be always be a TV commercial or industry funded “awareness campaign” to convince you otherwise.

Then once we are at the doctor, we have been conditioned that it’s wrong to bring financial considerations into the picture. We are used to be overdiagnosed, overtreated and overmedicated. And unfortunately, it’s going to be hard to change that norm.

But I do think the whole system needs an overhaul and that any discussion of health care reform has to be more than playing hot potato with the bill. And I don’t see that happening.

Last edited by Ann Hedonia; 08-14-2019 at 08:37 AM.
  #74  
Old 08-14-2019, 01:43 PM
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II sure hear much more frequently of ridiculous amounts of care being provided to someone who is already quite decrepit and dies soon despite the care provided.
Oh, man, I saw so much of that when I worked in hospitals! Most of the time, it wasn't even the patient's decision, but rather that of ONE RELATIVE, usually a child but sometimes a sibling who showed little interest until the very end and swooped in to make all the decisions, who was in massive denial and couldn't let go.

This is not the same as, for instance, not shutting off life support until all the children have arrived.

Last edited by nearwildheaven; 08-14-2019 at 01:45 PM.
  #75  
Old 08-14-2019, 02:46 PM
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Another prime example of this was the law that insurers had to spend 80% ( or was it 85%) of what they collected in premiums towards actual healthcare expenses.

This law lead to increased prices across the industry. Because it turns out that the insurers don’t have a lot of incentive to haggle with their suppliers if they don’t get to keep their savings.

And while I am HIGHLY critical of the pharmaceutical industry, it don’t think they are evil price gougers cackling insanely while killing people. (And I don’t call them Big Pharma). And I think dismissing legitimate criticism as a liberal meme only serves to make the situation worse. It’s denial of a real and serious set of problems.

They are a business. They are doing what businesses do. They are developing products and trying to get those products consumed by as many people as possible. They are developing pricing and marketing strategies to make as much money off these products as possible. They are lobbying for laws that will make it easier for them to accomplish these goals

Even though I’m liberal, I’m a capitalist and a successful business owner. I generally believe in these principles. But the biggest problem here is that the products aren’t iPhones, they include powerful psychiatric medications and highly addictive drugs with serious side effects. And the constant push to expand the customer base for these products has the potential to cause great personal and societal harm.

(There are other problems with the industry such as the widespread use and acceptance of surrogate endpoints leading to drugs that reduce a “number” or shrink a tumor without providing any evidence that the drug action confers a benefit to survival or quality of life, but that’s for another discussion.)


And when you combine the pharmaceutical industry with the insurance based healthcare system, you end up with a massive free market distortion where there is no force applying any downward pressures on pricing.

The patients, if insured, are paying a flat rate per month and have little incentive to be cost conscious regarding individual items. And any attempt to control costs by the entity that’s actually paying the bill makes them the bad guy.

For example, many insurance companies require that patients try a 30 day course of an older cheaper drug before they will pay for an ultra-expensive version that is virtually identical except for a few insignificant molecular tweaks. Now I think this is a perfectly reasonable policy in most cases. And I bet that any patient forced to make a rational economic decision between a drug that costs $30 a month and a drug that costs $3000 a month would agree to that condition if they were paying the bill themselves.

But this policy is wildly vilified.

Several years ago, 3 doctors at Sloan-Kettering refused to add a drug to their formulary because they did not feel the benefits it conferred were worth the outrageous financial cost. This was a bold move that I truly hoped would catch on, but unfortunately it didn’t. I think they did succeed in getting the prices lowered for that particular drug that one time, though.

The medical industry has conditioned us well. We are taught to demand the best and most expensive treatments for even the most minor conditions. And if you don’t think anything is wrong with you, there will be always be a TV commercial or industry funded “awareness campaign” to convince you otherwise.

Then once we are at the doctor, we have been conditioned that it’s wrong to bring financial considerations into the picture. We are used to be overdiagnosed, overtreated and overmedicated. And unfortunately, it’s going to be hard to change that norm.

But I do think the whole system needs an overhaul and that any discussion of health care reform has to be more than playing hot potato with the bill. And I don’t see that happening.
I think this is an excellent post.

What you're describing about people blaming drug companies is analogous to people blaming evil bankers for the 2008 financial crisis. Now, it may well be true that some bankers and drug companies are evil. But nothing should depend on this. What we need in both banking and healthcare is sensible government policies to organize and regulate the free market so that it operates in the public interest. All that we should then require of profit-oriented participants in the free market is that they follow the law in competing with one another. The public interest should not depend on their goodwill. If it does, the legal and regulatory framework is not fit for purpose.
  #76  
Old 08-14-2019, 03:35 PM
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Lots of people agree. My mother's doctor has talked to her about the possibility of getting a kidney transplant if her kidney disease progresses. And she said, "no, that's a bad use of resources. I'm old and have other health issues. It's not responsible to expend that sort of resource on me."

I don't know how common that sentiment is among people who are actually looking death in the eye.
I don't know how common it is, either; but I've known a number of people who reached a point at which they declined further treatment, even though it was available to them. Their motivations may not have all been about use of resources; but some people who are dying reach a point at which they're ready to go -- and not necessarily because they're in any acute distress.

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In what world is mid-70s not ancient?
In a world in which in some families living into the 90's isn't unusual, and an increasing number of people break 100, some of them still in good enough shape to be enjoying it and to be benefitting other people's lives?

Some people are ancient in their mid-70's, yes. Not everybody is.
  #77  
Old 08-14-2019, 03:45 PM
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In what world is mid-70s not ancient?
I'll be 74 in several weeks. My health is far from great, but I'm certainly not anywhere near "ancient".
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Old 08-14-2019, 05:13 PM
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I don't know how common it is, either; but I've known a number of people who reached a point at which they declined further treatment, even though it was available to them. Their motivations may not have all been about use of resources; but some people who are dying reach a point at which they're ready to go -- and not necessarily because they're in any acute distress.
In many cases, resources have nothing to do with it; they feel that they have just plain old lived long enough and in many cases, treatment of their illnesses may have reached a futile stage and they want to depart before their QOL declines any further.

There's a story going bacterial on Facebook about a 90-year-old woman who found out she had cancer, and she declined chemo and decided to go on a road trip with her dog. I'm not sure if the story is real, but there are very few situations where anyone would give chemo, at least the standard therapies, to a 90-year-old. Jimmy Carter received a targeted therapy, not really a "drug" but a biological which was the right one for him.
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Old 08-14-2019, 05:19 PM
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There's a story going bacterial on Facebook about a 90-year-old woman who found out she had cancer, and she declined chemo and decided to go on a road trip with her dog. I'm not sure if the story is real...
90-Year-Old With Cancer Says No To Chemo And Yes To Travel And Camper
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Old 08-14-2019, 06:28 PM
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For example, many insurance companies require that patients try a 30 day course of an older cheaper drug before they will pay for an ultra-expensive version that is virtually identical except for a few insignificant molecular tweaks. Now I think this is a perfectly reasonable policy in most cases. And I bet that any patient forced to make a rational economic decision between a drug that costs $30 a month and a drug that costs $3000 a month would agree to that condition if they were paying the bill themselves.

But this policy is wildly vilified.
The problem here occurs when the patient has done the $30 a month drug and had severe problems with it, then goes on to the more expensive drug.

Then has a new insurance provider, maybe because the person changed jobs or because the person's company has changed insurance providers. And the new insurance company insists on the 30-day course of the cheaper drug, even though the patient had a bad reaction to it before, or it just doesn't do what the patient needs it to do.
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Old 08-14-2019, 06:31 PM
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...Then has a new insurance provider, maybe because the person changed jobs...
This is the root of the problem.
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Old 08-14-2019, 07:21 PM
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In a world in which in some families living into the 90's isn't unusual, and an increasing number of people break 100, some of them still in good enough shape to be enjoying it and to be benefitting other people's lives?

Some people are ancient in their mid-70's, yes. Not everybody is.
It's still ancient. Doesn't mean you can't be in reasonably good health and do a lot of things, it's still very old. That's all ancient means.
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Old 08-14-2019, 07:42 PM
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...For example, many insurance companies require that patients try a 30 day course of an older cheaper drug before they will pay for an ultra-expensive version that is virtually identical except for a few insignificant molecular tweaks. Now I think this is a perfectly reasonable policy in most cases. And I bet that any patient forced to make a rational economic decision between a drug that costs $30 a month and a drug that costs $3000 a month would agree to that condition if they were paying the bill themselves.
I started a new thread on this topic here.
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Old 08-14-2019, 07:53 PM
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In what world is mid-70s not ancient?
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...My personal thought is that if you make it to your mid-70s in somewhat decent health, you've had a pretty good run.
FWIW, I just got back from a week-long canoeing trip down the Allagash River in Maine. We went a total of 60 miles in 5 days. One of the guys in our group is 72 years old, and nobody can keep up with him. He also hikes, bikes, and goes downhill skiing.
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Old 08-15-2019, 03:59 AM
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FWIW, I just got back from a week-long canoeing trip down the Allagash River in Maine. We went a total of 60 miles in 5 days. One of the guys in our group is 72 years old, and nobody can keep up with him. He also hikes, bikes, and goes downhill skiing.
When my father retired, he took up teaching windsurfing to people a third his age and went to Cape Hatteras twice a year to windsurf. He was thrilled to turn 70 because it meant he could get free lift tickets at some ski resorts. At 90 he still goes to the gym and does Zumba classes a couple times a week, and recently did five sets of 25 pushups each over the course of a one-hour exercise class.

Some people just power on until they drop.
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Old 08-15-2019, 05:23 AM
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In what world is mid-70s not ancient?
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Originally Posted by thorny locust View Post
In a world in which in some families living into the 90's isn't unusual, and an increasing number of people break 100, some of them still in good enough shape to be enjoying it and to be benefitting other people's lives?

Some people are ancient in their mid-70's, yes. Not everybody is.
There are people who are ancient in the 50s. Not everybody has good genes. If someone still has a life expectancy of 10+ years, based on family history, I do not consider them ancient.

For me, I'll call my parents ancient after they reach the age of their parents' death. Most of my grandparents passed away after 84, and even many of my greatgrandparents were over 85 when they passed away. Of course I am biased. But my parents are still doing more at their age that others do at 20 year younger.

And, I would like to see someone call my mother timid. They might not live.
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Old 08-15-2019, 06:45 AM
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Of course, there are all kinds of problems with the for-profit healthcare industry, which should be addressed.

But I believe SOME sort of rationing is necessary. I did not see in the story what the medical conditions/expenses were. Mid-70s isn't ancient, but it isn't young either. Some cost/benefit analysis of what expense for how many quality years is appropriate. If you are old enough and sick enough, IMO you ought to be provided palliative care - and options for assisted suicide.
And right wing US politicians like to say the NHS has death panels. Blimey o'Riley.
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Old 08-15-2019, 09:33 AM
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Not everybody has good genes. If someone still has a life expectancy of 10+ years, based on family history, I do not consider them ancient.
"Old" has been "ten years older than me" since I was about eight.
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Old 08-15-2019, 09:41 AM
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I'll be 74 in several weeks. My health is far from great, but I'm certainly not anywhere near "ancient".
Welllll…… You may not be, but you could see it from where you are. Back in the day.
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Old 08-16-2019, 02:28 PM
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There are people who are ancient in the 50s. Not everybody has good genes. If someone still has a life expectancy of 10+ years, based on family history, I do not consider them ancient.

For me, I'll call my parents ancient after they reach the age of their parents' death. Most of my grandparents passed away after 84, and even many of my greatgrandparents were over 85 when they passed away. Of course I am biased. But my parents are still doing more at their age that others do at 20 year younger.

And, I would like to see someone call my mother timid. They might not live.
We are definitely using ancient in a different way. I'm using it to mean very old, with no judgment implied. You can feel ancient when you're still relatively young, but the same goes for feeling old, and I know some people do still try to claim mid-70s isn't old, either, but it is. That's why it's impressive when people of that age are still really active. It is relative, of course - a professional footballer in their forties is old, while in most of the rest of life they're not - but there are very few circumstances where someone in their 70s isn't at the very least old.

Can 80 be ancient? Or is it such a pejorative word that it should never be used?
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Old 08-18-2019, 01:07 PM
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Big Pharma CEO: ‘We’re in Business of Shareholder Profit, Not Helping The Sick’
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“My primary responsibility is to Valeant shareholders. We can do anything we want to do. We will continue to make acquisitions, we will continue to move forward,” Pearson said.

He added: “If products are sort of mispriced and there’s an opportunity, we will act appropriately in terms of doing what I assume our shareholders would like us to do.”
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Old 08-18-2019, 01:36 PM
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He's correct. It's not the purpose of private for-profit corporations to establish sensible healthcare policy or to serve some social welfare function. I refer you to post #75.
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Old 08-18-2019, 02:55 PM
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The problem here occurs when the patient has done the $30 a month drug and had severe problems with it, then goes on to the more expensive drug.

Then has a new insurance provider, maybe because the person changed jobs or because the person's company has changed insurance providers. And the new insurance company insists on the 30-day course of the cheaper drug, even though the patient had a bad reaction to it before, or it just doesn't do what the patient needs it to do.
Don't get me started on those $4 lists.
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Old 08-18-2019, 03:39 PM
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Of course, there are all kinds of problems with the for-profit healthcare industry, which should be addressed.

But I believe SOME sort of rationing is necessary. I did not see in the story what the medical conditions/expenses were. Mid-70s isn't ancient, but it isn't young either. Some cost/benefit analysis of what expense for how many quality years is appropriate. If you are old enough and sick enough, IMO you ought to be provided palliative care - and options for assisted suicide.
Currently the US rations healthcare far more severely than other western nations, and end up with costs far in excess of them (and generally poorer results).

Perhaps you should actually address the issues with a for-profit healthcare system before considering even more rationing.
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Old 08-18-2019, 03:57 PM
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Can 80 be ancient? Or is it such a pejorative word that it should never be used?
I'm not sure it is pejorative, exactly. Myself I just find it a slightly weird word to apply to people except as hyperbole - "man that guy over there looks really ancient." To me ancient implies something really, really old. REALLY old. I don't think of Dover Castle as ancient, but the Parthenon qualifies.

Might be an American English vs. UK English usage issue, or it might just be me. Probably just me.
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Old 08-18-2019, 04:10 PM
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I posted this in another thread on the subject of health care. It seems to be relevant to the discussion here, if only as a point of comparison:

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My very local paper ran a human interest story this weekend. It was about a local family whose daughter, at the age of 13 was diagnosed with something like a weak blood vessel in the brain. (Unclippable uncoilable MCA) In a very difficult location. She was put on a "watchful waiting" program. About 2 years ago, when she was 17, there were signs that it was weakening further and might rupture soon. It seems to be a very rare thing, and required specialization was not available locally. The family went to the USA, to a New York based Dr. Amir Dehdashti.
Among the things that were explained to them at the hospital was that a down-payment of 35 000 $ was expected before they even got to see the doctor. That led to some nervous laughter, pf curse it wouldn't cost them anything. Its all paid for by the health care system.

The operation was successful, otherwise I guess it wouldn't have made a good human interest story. During the days in New York the family mentions passing an ambulance trying to tend to someone who'd been involved in an accident. The bleeding man did not want to go in the ambulance because he could not afford it. It did make them reflect on how they'd gotten shipped across the world to best specialists, all covered by the Norwegian health care system, while the Americans in the same city could not afford an ambulance.

Which makes me think: If you really need it, the odds of seeing the best specialists in the US are probably better for the average Norwegian than for Joe Average American. Maybe way better. So the current US system is working quite well for us. Not so much for the nation whose people may have to refuse ambulances when injured, because they can't afford them. And count themselves lucky they were not unconscious and unable to refuse the ambulance.
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Old 08-19-2019, 03:23 AM
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But in most of the developed world that means saying - in very, very toned down words - "I'm sorry, you're 75 and chemo would make your remaining years terrible while costing the health service lots of money.
No, the triage isn't exclusively age-based. Someone can be 75yo and a crapshoot, someone else can be 75yo and in ridiculously good health. My mother and a friend of hers (similar age, both about 75 in fact) got the same diagnostic (diverticulitis) from the same doctor; Mom went into "let's try everything we possibly can in order to avoid surgery" while the friend was offered surgery straightaway (eventually they both had the same surgical team). Friend has a normal-for-their-age medical history, with the only prior big problem being a ton of allergies and the only previous surgery being for her tonsils; Mom's history overflowed 3 folders before it was digitized and it got digitized 20 years ago.
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Last edited by Nava; 08-19-2019 at 03:27 AM.
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Old 08-19-2019, 05:24 AM
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Tragic OP. More people should be aware that there is a thing called Medical Tourism. There are many places in the world where you can get top-notch medical care, including all kinds of surgery, for a fraction of the cost in the US. For example, insulin is incredibly cheap in India (relative to US standards). Is it not possible to visit India, establish yourself with an endocrinologist there, and have insulin shipped out to you with a prescription? I do not know about the legality of this, though. I would think the DEA would balk at narcotic painkillers and stuff like that, but maybe not insulin and regular medication.
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Old 08-19-2019, 08:50 AM
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Tragic OP. More people should be aware that there is a thing called Medical Tourism. There are many places in the world where you can get top-notch medical care, including all kinds of surgery, for a fraction of the cost in the US. For example, insulin is incredibly cheap in India (relative to US standards). Is it not possible to visit India, establish yourself with an endocrinologist there, and have insulin shipped out to you with a prescription? I do not know about the legality of this, though. I would think the DEA would balk at narcotic painkillers and stuff like that, but maybe not insulin and regular medication.
Insulin must be kept refrigerated. I'm very wary of getting it shipped, even from Canada. In fact, I just take it on blind faith that my insulin is kept refrigerated on its way to my local pharmacy.
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Old 08-19-2019, 11:46 AM
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I'm not sure it is pejorative, exactly. Myself I just find it a slightly weird word to apply to people except as hyperbole - "man that guy over there looks really ancient." To me ancient implies something really, really old. REALLY old. I don't think of Dover Castle as ancient, but the Parthenon qualifies.

Might be an American English vs. UK English usage issue, or it might just be me. Probably just me.
Not just you. "Ancient" to me means not just old, but extremely and unusually old. When applied to a living being, it also carries a connotation of decrepitude; though it doesn't carry that connotation if applied to, say, literature.

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No, the triage isn't exclusively age-based. Someone can be 75yo and a crapshoot, someone else can be 75yo and in ridiculously good health.
This, also. Some people at 75 can reasonably expect to have more good years left, if they get proper medical care, than some other people who are 50, and also more than some other people who are 5, or 5 months.

If there's only one kidney available, and every other factor is equal, then yes I'd give it to the 50 year old and not the 75 year old, and if it'll fit I'd give it to the 5 year old, though I don't know whether small children can use adult kidneys. But every other factor is very rarely equal. And it's also important to be working on making more kidneys available and on creating artificial ones and on treatments for kidney disease, so the problem comes up less often in the first place.

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Is it not possible to visit India, establish yourself with an endocrinologist there, and have insulin shipped out to you with a prescription?
I also don't know whether that's legal; but even if it is, why do you think that people who can't afford their insulin can afford trips to India?

There is definitely such a thing as medical tourism. It, like non-medical tourism, requires both available money and available time. It's another instance of 'people who already have money can often get things cheaper than the price that people who don't have money have to pay for them'.
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