I’d like to throw this toward Brian – Insurance companies are making decisions about people’s health care all the time. Bureaucrats motivated by profit are making decisions about what kind of health care you’re allowed to receive under their plans. If you want procedures they aren’t covering, you are welcome to pay for them out of your own pocket.

Please explain to me how this is o.k., but a public option is not.

I appreciate your thoughtfulness and your passion on this issue.

Maybe I haven’t stated my position clearly enough. I have no desire for anyone besides the patient and physician to make a decision. Instead, I want to start a debate so that the public is more informed about end-of-life issues. I like a serious debate that includes physicians, ethicist, the clergy (Catholic, Protestant, Jewish, etc.). All we’ve had in this country is heated and inflammatory rhetoric.

I want the government to fund studies on end-of-life issues. If physicians are given sufficient data, maybe we were able to identify patients who were in the dying process much much earlier. Therefore, we can inform the families — much, much earlier.

Republicans have harped on the fact that the government is full of fraud and waste. Yet, we know that private companies are also full of fraud and waste. We’ve also seen bloated salaries in the private sector. We’ve seen the private sector ration healthcare by limiting coverage and increasing premiums. The government is us. If we want the government to work well, we must employ qualified, thoughtful intelligent people. Everyone fraud and abuse that we should hire somebody from the private sector who stands to reap personal benefits from contracts are being handed out. The quickest way to become a millionaire, in the year 2009, is not to come up with a business plan and go to a bank and try and find funding instead, it is to come up with a business plan, find a lobbyist and win a government contract.

Thanks for your comment.

How many bad apples spoil an otherwise useful social program like Social Security or Medicare? How many Irresponsibles does it take to justify dismantling a program beneficial to the other 300 million Americans?

Ballpark. What percent?

For perspective, keep in mind that over $10 billion in Iraq reconstruction cash delivered to Baghdad shrink-wrapped on pallets simply vanished. Until Democrats took over this January, congressional Republicans showed little interest in the Irresponsibles behind that waste and inefficiency.

On the health care cost issue, critics of health care reform have pointed to what the CBO cautions is an incomplete analysis that put the ten-year cost of two draft Senate proposals at over $1 trillion. Yet the Lewin Group estimates the savings from one such plan (similar to the Tri-Committee bill) developed by Prof. Jacob Hacker “would provide health care coverage for virtually every American while generating huge cost savings — more than $1 trillion over 10 years” while while expanding coverage to those 47 million. http://www.ourfuture.org/healthcare/Lewin-Group-report

It’s not just about what it costs, it’s also about what it saves and how many it covers along the way.

The physician’s role should be to educate and help the unequipped family become properly equipped to make the appropriate decision. However, the decision should ultimately be the decision of the patient or the patient’s family no matter how “unequipped” anyone else feels they are.

My statement that government is the problem was a slogan of Regan and Nixon, but that doesn’t make it wrong. The government is already the largest insurance company in our nation, yet waste, fraud, and abuse in medicare and medicaid are rampant. To think that this won’t happen the new program would be foolish.

You make an excellent point. Unfortunately, most families are totally unequipped to truly weigh the risk and benefits of continuing specific therapies. This is a fact. There are some families that are excellent and make the right decision. (No matter what that right decision is.) I guess we need a better way of identifying patients so that physicians can better inform families of realistic options. The only way that the government should be involved is in funding studies to better identify patients prospectively. Also, with the specter of lawsuits always looming over physician’s head, physicians mostly error on the side of doing more which may not be the right thing for the patient.

I’m not sure I understand your last paragraph. It may be that I need more caffeine or that my bifocals aren’t in focus. The VA is a government run program. That is not what I have in mind. Instead, I have suggested a program that is run by physicians, hospitals and other healthcare professionals. The program is paid for by the American people.

Finally, we need to get past slogans that originated with Ronald Reagan and Richard Nixon. The government is us. If the government is the problem then we are the problem. The government is no more and no less than we the American people. When you fill the government with competent people you get an excellent outcome. When you fill the government was incompetent people who are looking to pad their resume and then become a corporate lobbyist (heckuva job Brownie), we get the government that we deserve.

Thanks for your comments.

Although the numbers aren’t crystal clear, it is commonly believed in the medical community than 50-70% of some patient’s overall medical expenditures are spent during the last six months of life. Therefore, if it is possible to identify these patients, prospectively, should we work on increasing the patient’s quality of life and not their quantity of life? This needs to be studied and thoroughly debated.

Shouldn’t it be the patient and the doctor that decide this? At which point would you propose that the government decides for care to increase a person’s quantity of life be withdrawn? I do agree with this premise somewhat that at some point a person should be “made comfortable” and let go of, after all we can’t live forever. However, I believe, a system called hospice currently exists by which this can occur. These decisions are made by the patient and patients family, usually (hopefully) after consulting with the patients doctor. Please correct me if I am wrong.

To address the rest of your post, currently government health care spending (thru Medicare, Medicaid, VA, etc. programs) makes up 46-56.1% of ALL health care spending in the United States. That means that the US Gov’t is already the largest insurance company in the country. Assuming your argument is correct and there is already enough money in the system, why would anyone want to expand the government’s role? It seems that Government is the problem not the solution.