Health Care Bill Debate

[Tiassa]

Look for the obvious

So how is this different from what happens in the US today.

Joe, I'm going to ask you to take a breath. And then I'm going to go to bed.

But ... it seems to me people are overlooking a couple of issues here. Perhaps because it's Mr. Roam. However, two quotes from the stories he offered:

• "Doctors there said he could not jump the queue and had not served the mandatory six-month period of being sober before having the operation."

• "He was expected to die within six months without a new liver, but two specialists at Ontario transplant centres said he was not a suitable candidate."​

With the first, it's a contentious issue in Britain. More to the point, there has been discussion in the last couple years about whether to give an alcoholic a new liver, anyway, much less allow one to jump the queue when he hasn't sobered up. We can flip coins for our personal opinions if we must, but I sincerely doubt that, under our present system in the U.S., an alcoholic would be pushed to the front of the line for a new liver.

And as to the second, we need to figure out what is meant by "not a suitable candidate". I don't know what Canada's standards are, but we can find some insight from the University of Southern California:

There are no age limits when considering patients for liver transplantation. The absence of significant disease in the heart, brain, lungs, and kidney would favor consideration for transplantation regardless of age. A patent portal or superior mesenteric vein is necessary for successful engraftment. If evidence of partial or complete thrombosis is apparent on initial imaging studies, then angiographic confirmation is recommended. Hepatopulmonary syndrome (hypoxemia related to cirrhosis) occurs occasionally and usually subsides following transplantation. Significant pulmonary hypertension, on the other hand, precludes transplantation since cardiac deterioration following engraftment inevitably occurs and is usually fatal. Patients who are HIV positive or who have psychiatric diseases such as depression and psychosis are not suitable candidates. Patients with a remote (greater than 5 years) history of malignancy in a nonhepatic site may be considered for liver transplantation.​

In either case, livers are not easily obtained. Wait periods can run from days to years; it depends on who dies and where.

One of the reasons Mr. Roam didn't credit his quote is that he didn't want people to read the rest of the story:

Professor Ian Gilmore is a liver specialist at the Royal Liverpool Hospital. He told the BBC Gary Reinbach was unlucky to be in his position at such a young age, and that the odds were stacked against him.

"The saddest aspect of this case is it's because of the severe shortage of donors livers that these decisions are faced every day," he said.

"And we know, for example, that those who do get onto a liver transplant list will wait on average more than three months before finding an organ.

"One in six of those who are accepted with a wide range of liver disease, will die. One in six dying before they get their transplant."

Professor Gilmore says it was a hard decision to say no to Gary Reinbach and his family.

"It's never one single person's decision, it's a multi-disciplinary team that review it, it's made on practical grounds," he said.

"We know that these patients, who present very acutely like this with no past history, actually don't survive transplantation as well as some other groups."

(Santow)​

And in the American debate, people are already aware that there are still some difficult questions to be addressed. Well, that or they're not paying attention. To the other, it seems rather stupid that one who sides with those who are disrupting the discussion at all should complain about what the discussion hasn't progressed to consider yet. We need to get the foundation laid before we can start stacking on the details.

In the meantime, we should ask Mr. Roam if an alcoholic should jump the queue for a liver, and whether he would be so outraged if a private insurance company had decided against Mr. Flora's liver transplant after two specialists said he wasn't a suitable candidate.

Anyway, when it's a troll like Mr. Roam, look for the obvious. It's usually there.
_____________________

Notes:

Selby, Rick. "Selecting Candidates for Liver Transplantation -- Who Qualifies?". Liver Newsletter. Liver Transplant Program and Center for Liver Disease at University of Southern California Department of Surgery. n.d. USCLiverTransplant.org. August 6, 2009. http://www.usclivertransplant.org/livernewsletter-selectingcandidatesforlivertransplatation.html

Santow, Simon. "22yo dies after being denied liver transplant". Australian Broadcasting Corporation. July 22, 2009. ABC.net.au. August 6, 2009. http://www.abc.net.au/news/stories/2009/07/22/2633055.htm

 

[pjdude1219]

The sad case of a young sick British man has raised new questions about the fairness of the rules for organ transplants.

Gary Reinbach, 22, an alcoholic, died yesterday after authorities in the UK refused to give him an emergency liver transplant.

Doctors there said he could not jump the queue and had not served the mandatory six-month period of being sober before having the operation.

The country is irrelevant. very few places will give an alcoholic a liver.

 

[Buffalo Roam]

No Tiassa, the reason that I didn't credit the story is that it doesn't matter where it happened or the situation, what matters is the fact that under UHC or private insurance it would have made no difference, only now, us average Joe's are in the same boat.

The Horrible Rich will still have a First Tier Health System that they can always buy into, and when they need a liver they will just buy it, but those of us who depend on Insurance will lose the access that Group Insurance buying power gives them to the First Tier Health System.

The lie of UHC is that things will be better, Britain, Canada, Australia, and their systems show that for the lie it is, and that is demonstrable by the numbers of patients that those systems, send to the U.S. for care that is not available under those systems.

 

[Tiassa]

(Insert Title Here)

Makes me feel naive for asking.

Oh, come now. It's easy enough to forget. Our voters do, all the time.

Ah. That explains why your left is like our right.

So to speak.

And they say Mcarthyism is dead. Why the hatred for even left leaning policies ?

Fear.

Given a choice between lofty and complex embodiments of basic principles and cheap appeals to emotion, Americans more often than not go with the latter.

Why not ?

Well, most Americans preach some sort of dignity. Maybe Democrats believe it to a greater degree. Classicist Norman O. Brown, in Life Against Death, re-examined Freud some twenty years after the founder of psychotherapy died:

... it is a Freudian theorem that each individual neurosis is not static but dynamic. It is a historical process with its own internal logic. Because of the basically unsatisfactory nature of the neurotic compromise, tension between the repressed and repressing factors persists and produces a constant series of new symptom-formations. And the series of symptom-formations is not a shapeless series of mere changes; it exhibits a regressive pattern, which Freud calls the slow return of the repressed, "It is a law of neurotic diseases that these obsessive acts serve the impulse more and more and come nearer and nearer the original and forbidden act." The doctrine of the universal neurosis of mankind, if we take it seriously, therefore compels us to entertain the hypothesis that the pattern of history exhibits a dialectic not hitherto recognized by historians, the dialectic of neurosis.

(11-12)​

Trying to sort out the implications of that notion as applies to Democrats, mudslinging, principles, and dignity is a bit ... um ... shall we say, difficult. But there it is.

There has to be a cause right ? People don't believe this shit without some extremely tenous link somewhere right? There is some faith in Evidence Right? The "beacon" of civilization must have some logic behind it.. .. please ?

Honestly, I think it has to do with our educational system. Americans are very good at certain things. But these days our instruction in civics is usually framed according to some personal controversy. That is, we learn about it because some issue compels us to. And logic? It's usually tied to geometry or computer science.

We are an incredibly innovative society, but the nature of our innovations might suggest a few things about where we are focusing our educational efforts. For instance, we invented most of the devices that just brought down our economy. Sounded great for a while, I suppose, but then shit went and broke, and we're not really sure how to fix things. Likely, we're just going to patch up the system with some really expensive bubble gum and pretend it's not going to break again.

Ah, The famous Horatio Alger myth strikes again.

Yes. You could say that.

I never got that either. Elitist generally means to surround oneself with the rich/powerful/upper class, and it is arguable Bush did that more than Obama.

I always enjoy hearing Republicans complain about "Hollywood elitists". Funny how they never mention Ronald Reagan, Sonny Bono, Clint Eastwood, or Fred Thompson.
_____________________

Notes:

Brown, Norman O. Life Against Death. Middletown: Wesleyan University Press, 1959.

 

[Repo Man]

No Tiassa, the reason that I didn't credit the story is that it doesn't matter where it happened or the situation, what matters is the fact that under UHC or private insurance it would have made no difference, only now, us average Joe's are in the same boat.

The Horrible Rich will still have a First Tier Health System that they can always buy into, and when they need a liver they will just buy it, but those of us who depend on Insurance will lose the access that Group Insurance buying power gives them to the First Tier Health System.

The lie of UHC is that things will be better, Britain, Canada, Australia, and their systems show that for the lie it is, and that is demonstrable by the numbers of patients that those systems, send to the U.S. for care that is not available under those systems.

I'm sure this won't dissuade you from posting, but no one here can take you seriously. You're a creationist, you take WND at face value (when it's actually a less credible source than The Onion) you're a birther... the list is quite extensive, and damning.

 

[pjdude1219]

No Tiassa, the reason that I didn't credit the story is that it doesn't matter where it happened or the situation, what matters is the fact that under UHC or private insurance it would have made no difference, only now, us average Joe's are in the same boat.

The Horrible Rich will still have a First Tier Health System that they can always buy into, and when they need a liver they will just buy it, but those of us who depend on Insurance will lose the access that Group Insurance buying power gives them to the First Tier Health System.

The lie of UHC is that things will be better, Britain, Canada, Australia, and their systems show that for the lie it is, and that is demonstrable by the numbers of patients that those systems, send to the U.S. for care that is not available under those systems.

What first world country is it legal to buy an organ?

 

[Challenger78]

For the record, As an Australian, Our healthcare system has it's problems, but it does the job for the majority of the population ,most of the time.

 

[joepistole]

And none of what the Republicans have proposed will cure the problem of runaway healthcare costs in the US. There is no good reason why we in the US pay more than twice what any other industrial nation pays for healthcare and receives a lower quality of healthcare.

 

[Buffalo Roam]

I'm sure this won't dissuade you from posting, but no one here can take you seriously. You're a creationist, you take WND at face value (when it's actually a less credible source than The Onion) you're a birther... the list is quite extensive, and damning.

And as I have said before, if the WND reports something you agree with, you crow it's brilliance from the Roof Tops, only when it doesn't support you contention does it become a less credible source than The Onion.

Now remember not to ever use WND as a source.

One simple question? if something wasn't up why not present the Long Form and totally blow the Birthers out of the Water.

A million dollars plus in legal fees to keep the Document out of the light?

When requested McCain had no problem producing His Long Form Birth Certificate.

I smell fish, rotten Fish.

 

[pjdude1219]

And as I have said before, if the WND reports something you agree with, you crow it's brilliance from the Roof Tops, only when it doesn't support you contention does it become a less credible source than The Onion.

Now remember not to ever use WND as a source.

One simple question? if something wasn't up why not present the Long Form and totally blow the Birthers out of the Water.

A million dollars plus in legal fees to keep the Document out of the light?

When requested McCain had no problem producing His Long Form Birth Certificate.

I smell fish, rotten Fish.

The data that would be gained in a long term birth certificate would be irrelevant unless you think who his doctor was and how much he weighed at birth are relevant. To demand it is nothing more than an invasion of privacy

 

[Alien Cockroach]

One of the major problems many Americans have with Obama is his constant rush to pass things before anyone even has a chance to read them, let alone debate the merits of any specific sections of the bill.

Every bill is an emergency. Every bill must be passed NOW. NO TIME TO READ IT. NO TIME TO LET THE PUBLIC HAVE A SAY. JUST PASS IT. TRUST US.

Those are the tactics of used car salesmen, not leaders.

Yeah, he should slow it down, so you can accuse him of being indecisive and lacking leadership.

Remember kids, the best way to avoid being thrown off-balance by any Jiu-Jitsu move is to stay focused, and follow-through. The enemy does not have any real power over you; it is nothing more than a fiction of his own invention, and he is trying to persuade you to believe in it. Look: you are not truly being thrown unless you believe that you are being thrown. You are not immobile unless you believe that you are immobile. The enemy's moves are based on rapid rhetorical reflexes, and we can't beat him at his own game. Our game is one of tenacity, fortitude, and focus, and that is not a game that the enemy knows how to play. The enemy wants you to think that this is against the rules, but it is not. The best way to deal with the enemy is to remember, always, that he is a fraud to the bone. The instant you forget this, he has power over you.

In any case, what our friend here is raving about now is the fact that Obama has been one of the most decisive and energetic politicians the White House has seen in years. Anthony is trying to deceive you by presenting a comparison between Obama and a fast-talking used car salesman. MadAnthonyWayne is completely making the likeness up. If you listen, you will find that Obama actually pauses very frequently in his speech, and he really prefers situations in which he has the time to focus and collect his thoughts. He was criticized during his campaign for being relatively poor at dealing with debates in spite of doing well when either writing a book or delivering a speech. This is just the kind of man that Obama is. He has a need for focus and composure.

MadAnthonyWayne does not actually believe that Barack Obama resembles a used car salesman, and he is lying as usual. If you have not realized by now that Anthony lies compulsively, I do not know where you have been or what you are on. At this point, I think I would be justified in laughing my butt off at anyone who tried to defend this guy. People like MAW aren't even good for sharpening my claws anymore. This has gotten to the point of being laughable. In any case, what MadAnthonyWayne does know is that Barack Obama has been one of the most decisive and active presidents we have ever had. A president who has this man's level of energy, stamina and focus is nearly unprecedented. He has dedicated a part of that energy to making his government one of the most open, transparent governments in world history.

 

[Buffalo Roam]

And none of what the Republicans have proposed will cure the problem of runaway healthcare costs in the US. There is no good reason why we in the US pay more than twice what any other industrial nation pays for healthcare and receives a lower quality of healthcare.

Really joe? and you can prove that?

Then why does the rest of the world come to America when their own countries UHC systems fail them.

Yes joe, from Canada, England, Iran, India, Germany, France, the Rich come to America, and we bring the poor to America when their systems cannot or will not care for them.

Yes problems with runaway health care can be traced to Government Mandates and Interference in the System.

The Government doesn't have to make a profit, it just demands more money and makes everyone pay for what it will not pay.

For every dollar that the Government doesn't pay, be it because of it's mandate to treat illegal aliens, to the money it doesn't pay in Medicare or Medicaid by using the Usual and Customary Charges dodge, (and at best only paying 60% of the cost) that dollar must be made up some where, so it is passed on to the rest of the Heath Care System in higher cost born by the Insurance Companies and the Individual in higher medical cost.

joe, I am part of a Government Run Health system, the V.A. and guess what?

Even they are sending patients to the Private Health Care System because they don't have the facilities to treat their patients in a timely manner, in the last year, 3 times I have been sent to the Civilian Heath Care systems for care, and 5 time in the last 2 years, so tell me joe, when the Government has it's UHC system where are they going to send the patient when they don't have the time, money, or equipment, to treat you in a timely manner?

Huh joe, where?

 

[spidergoat]

They come here if they can afford the good doctors. We go to foreign countries when we cannot afford the price of US care. It's called medical tourism.

The government doesn't have a mandate to treat illegal aliens, that's the doctor's oath. They cannot turn anyone away for emergency treatment.

 

[Buffalo Roam]

They come here if they can afford the good doctors. We go to foreign countries when we cannot afford the price of US care. It's called medical tourism.

The government doesn't have a mandate to treat illegal aliens, that's the doctor's oath. They cannot turn anyone away for emergency treatment.

Really and what is this about then? 42 U.S.C. § 1395dd, EMTALA;

The Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.

EMTALA applies to "participating hospitals", i.e., those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. However, in practical terms, EMTALA applies to virtually all hospitals in the U.S., with the exception of the Shriners Hospitals for Children, Indian Health Service hospitals, and Veterans Affairs hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004,[1] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, and not just to Medicare patients.[2][3]

The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[4] Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented".[5] More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care.[6] There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.

1.^ Key Medicare and Medicaid Statistics
2.^ Text of act
3.^ EMTALA site [1]
4.^ American College of Emergency Physicians Fact Sheet: EMTALA accessed 2007-11-01
5.^ Emergency Medical Services At the Crossroads, Institute of Medicine, 2006-06-14, accessed 2007-10-05
6.^ a b c Fact Sheet: The Future of Emergency Care: Key Findings and Recommendations, Institute of Medicine, 2006,

 

[Alien Cockroach]

The Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.

Oh, I have friends and acquaintances who are alive today because of this law. You don't always have your identification on you in the event of being involved in an accident. This is a very good program. Collectors who do business with hospitals, though, all seem to have Mafia connections.

 

[joepistole]

And as I have said before, if the WND reports something you agree with, you crow it's brilliance from the Roof Tops, only when it doesn't support you contention does it become a less credible source than The Onion.

Now remember not to ever use WND as a source.

One simple question? if something wasn't up why not present the Long Form and totally blow the Birthers out of the Water.

A million dollars plus in legal fees to keep the Document out of the light?

When requested McCain had no problem producing His Long Form Birth Certificate.

I smell fish, rotten Fish.

Only in your dreams Buffalo Roam. The article was so full of poop it wasn't even funny. I liked the part when it cited that Kenya delcared itself a republic in 1963. What it did not say was that Kenya delcared itself a republic in December of 1963. The birth certificate says Obama was born in August 1963. So you still have a timing issue...oops.

 

[joepistole]

Really and what is this about then? 42 U.S.C. § 1395dd, EMTALA;

The Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd, EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.

EMTALA applies to "participating hospitals", i.e., those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. However, in practical terms, EMTALA applies to virtually all hospitals in the U.S., with the exception of the Shriners Hospitals for Children, Indian Health Service hospitals, and Veterans Affairs hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004,[1] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, and not just to Medicare patients.[2][3]

The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[4] Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented".[5] More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care.[6] There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.

1.^ Key Medicare and Medicaid Statistics
2.^ Text of act
3.^ EMTALA site [1]
4.^ American College of Emergency Physicians Fact Sheet: EMTALA accessed 2007-11-01
5.^ Emergency Medical Services At the Crossroads, Institute of Medicine, 2006-06-14, accessed 2007-10-05
6.^ a b c Fact Sheet: The Future of Emergency Care: Key Findings and Recommendations, Institute of Medicine, 2006,

So you are saying it is ok to kill people by withholding emergency treatment simply because they have no proof of ability to pay? And you are the same guys screaming about taking a brain dead patient off of life support.

 

[spidergoat]

Really and what is this about then? 42 U.S.C. § 1395dd, EMTALA;

Well, that sounds like a great law. I didn't know about it. What would you propose, that an illegal resident get thrown on the street when they are dying?

 

[Baron Max]

Well, that sounds like a great law. I didn't know about it. What would you propose, that an illegal resident get thrown on the street when they are dying?

No, of course not, Spider! They'd just call one of the bleeding-heart, doo-gooder liberals on the long, long list of bleeding-heart, doo-gooder liberal list and easily find one of those bleeding-heart, doo-gooder liberals to pay for any and all threatment necessary. I mean, you'd pay for it, right? You love all those illegals, right?

Baron Max

 

[Gustav]

In either case, livers are not easily obtained. Wait periods can run from days to years; it depends on who dies and where.

which brings us to steve jobs's liver transplant (mantle got his in one day)

The reason that some people might be able to get transplants more quickly is that they're standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country -- and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) -- a patient can, in theory, be evaluated by all the transplant centers in the country.

unos uses meld to assess severity of illness and allocates on that basis. the nation is divvied up into regions with locals getting priority first, the rest later

shalala urged prioritizing sickest

overview of wait times

And in the American debate, people are already aware that there are still some difficult questions to be addressed.

hmm
joe the wino vs sweet lil jane
i'll play god if no one else wants to