[Chrysostom]

Originally Posted by JerryLove

I think when people say "healthcare", they mean "some healthcare". I might go so far as to say "reasonable healthcare".

"healthcare" is "things that promote health". In this instance, it refers to medical intervention aimed at bringing your condition toward nominal (few believe botox is "healthcare").

Not everyone will agree on where the limits of "reasonable" are, and not everyone will agree on where the line between "health" and "vanity" lies... but there's certainly some consensus ground.

Even if we assume we're talking about "health" as opposed to "vanity" (and I think the distinction is increasingly blurred), you can easily spend $100 million trying to keep somebody alive for ten more days, so the limit of "reasonable" is not "vanity." At best it would be "what seems affordable." But the present outcry is that healthcare is not affordable, so obviously the limit of "reasonable" cannot be "what seems affordable."

Originally Posted by JerryLove

Then we change the standard to reflect the conditions.

I'm not saying, What happens when new stuff is developed, which I think is the question you're answering. I'm saying, How much do we develop? What is "reasonable" to spend on R&D? The criteria that seem to work best for determining what is "reasonable" for today -- effectiveness, affordability, etc. -- do not apply to R&D, so when it comes to R&D even if we thought we had guidelines for what is "reasonable" before we've lost them completely.

Originally Posted by JerryLove

One of the more controversial questions. Ho much expense is reasonable for the millitary? What is a human life worth?

Despite the rhetoric, it has a real numeric value... though what that value is varies.

If the US could "save the world" for $1, would you support it? I suspect so.
If $100-trillion might save one person would you support spending that? I don't think any of us would.

Where in between we draw the line is complicated.

This would simplify things, since if people are convertible into dollar values then the limits of "reasonable" can be easily defined in terms of those dollar values.

I in no way intend this as name-calling, but to convert a person into a dollar value strikes me as really, really horrible. The ultimate triumph of capitalist consumerism. Again, I point at the villain who forces you to choose between the death of your son or daughter: You are forced to make a choice, but either way it wasn't a good one.

Originally Posted by Danny

To me, the definition breaks down into two distinct segments: preventive care, and emergency care.

Preventive care is pretty simple: It is access to products and services which help to prevent serious problems from occurring. This includes regular checkups and counsel from a doctor, and access to certain preventive medications (blood pressure and cholesterol medication, smoking cessation aids, etc.) as recommended by a doctor.

Emergency care is equally simple: It's access to prompt corrective action after **** hits the fan. Surgery, wound dressing, diagnosis and treatment of illnesses, etc.

Preventive care is a lot cheaper than emergency care in many situations (cholesterol medication and good advice on lifestyle changes is a hell of a lot cheaper than coronary bypass surgery, and a prescription for Chantix is a lot cheaper than chemo), and allowing access to the former will dramatically decrease demand for the latter, freeing up more money and resources to be utilized for the latter when it is necessary.

And furthermore, although it may be outside the scope of this discussion, the practical real-world evidence is heavily in favor of this. Countries with single-payer healthcare which includes preventive care enjoy higher life expectancy numbers, lower rates of preventable illnesses and health conditions, and (and this is definitely beyond the scope of discussion here, but still worth mentioning at least in passing) overall higher quality of life and better economies.

Hmm, you don't seem to be answering the question I'm really asking. I'm not asking what kinds of this fall within the span of the category "healthcare." I've been to see a doctor before. That "healthcare" is a broad field that is quantified as a consumer good and purchased/accessed by consumers to varying degrees. When someone says "I can't afford healthcare" that person doesn't mean that s/he can't afford band-aids and aspirin. Instead, we're looking at some point in the spectrum.

And I deny that there can be such a point, even when fuzzily defined, in principle.

Originally Posted by Danny

R&D is an area where the U.S. is doing pretty well, with the exception of funding restrictions for stem-cell research (which will be lifted as soon as Bush leaves office, as his veto pen is the last remaining road block on that front). Keeping it at current levels is sufficient, as far as I can tell.

You're saying that the current situation is (nearly) good enough, but you're not answering the deeper question -- what does "good" mean here? Healthcare can never bring a final end to human sickness or mortality, so insofar as it is a consumer good there can be no limit to what is "good" or "necessary" or "reasonable."

[BillSPrestonEsq]

John, what do you make of limited quantities of drugs? Some of the drugs my wife actually uses are actually in quite short supply, and literally, you have to pick who gets the last dose. In the homeless woman scenario, someone actually, without thinking ran a drug out of hospital supply in a last ditch effort with basically no chance of success.

In other words, sometimes it isn't even as nice and neat as putting a dollar value on a life, as a craps shoot based on odds of survival. And when you pump a quarter mil worth of scarce drugs into a homeless woman... it is not about capitalism.

However, that day, if someone else had come into the hospital with a similar condition with a 50% survival chance with that drug, they would have died. Was it judicious to use it all on someone with less than a 1% chance?

A lot of stuff in healthcare is pure judgment calls.

And at some point, as crass as this sounds, you have to pick what kills you in an ICU. Is it going to be pneumonia, a failing heart, the renal failure, etc. Sometimes, its just plain cruel to keep the heart pumping. Once there is no chance of recovery... what then? My wife cares for these folks, and they already get healthcare. A lot of traumas that arrive on my wife's unit are doe's when they arrive. You get shot, hit by a truck, etc, and don't have an insurance card, you still get treated.

[Danny]

Originally Posted by Chrysostom

I'm not saying, What happens when new stuff is developed, which I think is the question you're answering. I'm saying, How much do we develop? What is "reasonable" to spend on R&D? The criteria that seem to work best for determining what is "reasonable" for today -- effectiveness, affordability, etc. -- do not apply to R&D, so when it comes to R&D even if we thought we had guidelines for what is "reasonable" before we've lost them completely.

I think you have sort of an odd understanding of medical research. It's not a field where you can just throw more money at it and watch developments happen faster or better. To take cancer development as an example, it's possible that it's only ultimately curable by nanobots which can intelligently target and eliminate individual cancerous cells. That sort of development will take years of research across multiple fields of science and engineering to come to fruition. Even if you diverted every cent of the national budget into cancer research, it doesn't necessarily mean you'll have a cure any faster. Science doesn't work that way. Heck, many of the most important scientific discoveries happen completely by accident.

I really don't understand how an adoption of universal healthcare suddenly makes R&D different somehow. Maybe I'm just not following you correctly.

When someone says "I can't afford healthcare" that person doesn't mean that s/he can't afford band-aids and aspirin. Instead, we're looking at some point in the spectrum.

And I deny that there can be such a point, even when fuzzily defined, in principle.

Again, I'm not sure I'm understanding your argument correctly, but it seems that the conclusion you're trying to arrive at is that universal healthcare is impossible because "reasonable" can't be defined. But it is quite obviously not impossible, since it's been realized in every other industrialized country on the planet. It's not a question of, "Can we do it?" it's a question of "How?" or "Can we do it better?" And for that, it would be simple enough to draw inspiration from any of the 52 countries that already have it, while adapting it to our own needs. If I'm following you correctly, it sounds like you're using Aristotelian physics to prove that human flight is impossible, but you're a century or so too late.

You're saying that the current situation is (nearly) good enough, but you're not answering the deeper question -- what does "good" mean here? Healthcare can never bring a final end to human sickness or mortality, so insofar as it is a consumer good there can be no limit to what is "good" or "necessary" or "reasonable."

Healthcare is not R&D. They're two distinct fields and they have to be treated as such. In the case of research, "good" simply means "sufficient." When the researchers have enough money to pursue the avenues they believe are promising, that's good enough. When they don't have enough money to conduct an important study which has a high likelihood of yielding results, that's not good enough. I can't tell you where that line is because I'm not a researcher, but that doesn't mean the line doesn't exist, or even that it's particularly fuzzy.

[Bryan]

Originally Posted by BillSPrestonEsq

John, what do you make of limited quantities of drugs? Some of the drugs my wife actually uses are actually in quite short supply, and literally, you have to pick who gets the last dose. In the homeless woman scenario, someone actually, without thinking ran a drug out of hospital supply in a last ditch effort with basically no chance of success.

In other words, sometimes it isn't even as nice and neat as putting a dollar value on a life, as a craps shoot based on odds of survival. And when you pump a quarter mil worth of scarce drugs into a homeless woman... it is not about capitalism.

However, that day, if someone else had come into the hospital with a similar condition with a 50% survival chance with that drug, they would have died. Was it judicious to use it all on someone with less than a 1% chance?

A lot of stuff in healthcare is pure judgment calls.

And at some point, as crass as this sounds, you have to pick what kills you in an ICU. Is it going to be pneumonia, a failing heart, the renal failure, etc. Sometimes, its just plain cruel to keep the heart pumping. Once there is no chance of recovery... what then? My wife cares for these folks, and they already get healthcare. A lot of traumas that arrive on my wife's unit are doe's when they arrive. You get shot, hit by a truck, etc, and don't have an insurance card, you still get treated.

I don't think we are having this discussion because of emergencies. If you get shot and taken to the emergency room, they have to provide life saving aid.

But take my friend's wife for example. She had a blood vessel in her eye socket that was malformed. This caused it to expand at time pressing her eyeball out, it looked like her eye was gonna pop out of her socket. To solve the problem they did major surgery that involved an anathesiologist, a plastic surgeon, and the opthamologist. The first obviously, knocked her out. The second doctor cut her face and peeled back the skin of her face over her head. He then cut out a small piece of bone so the eye doctor could do his job. The eye doctor installed two titanium clips that cut off the blood flow through that vein and then cut out the bad part. The vein remain clamped and they put her back together. My friend told me that this surgery, without health insurance, would have cost an insane amount of money and they would not have been able to afford it. The risk of not doing the surgery was a rupture of the blood vessel that would have blinded her in that eye. They aren't poor enough to get medicaid and they would have had to forego the procedure w/o insurance. I have a feeling that this kind of situation is the real reason we have a need for the universal healthcare.

Though I may be getting off topic with this.

[Chrysostom]

Originally Posted by BillSPrestonEsq

John, what do you make of limited quantities of drugs? Some of the drugs my wife actually uses are actually in quite short supply, and literally, you have to pick who gets the last dose. In the homeless woman scenario, someone actually, without thinking ran a drug out of hospital supply in a last ditch effort with basically no chance of success.

In other words, sometimes it isn't even as nice and neat as putting a dollar value on a life, as a craps shoot based on odds of survival. And when you pump a quarter mil worth of scarce drugs into a homeless woman... it is not about capitalism.

However, that day, if someone else had come into the hospital with a similar condition with a 50% survival chance with that drug, they would have died. Was it judicious to use it all on someone with less than a 1% chance?

A lot of stuff in healthcare is pure judgment calls.

And at some point, as crass as this sounds, you have to pick what kills you in an ICU. Is it going to be pneumonia, a failing heart, the renal failure, etc. Sometimes, its just plain cruel to keep the heart pumping. Once there is no chance of recovery... what then? My wife cares for these folks, and they already get healthcare. A lot of traumas that arrive on my wife's unit are doe's when they arrive. You get shot, hit by a truck, etc, and don't have an insurance card, you still get treated.

I'm not trying to be difficult, but I don't understand the question you're asking here.

Originally Posted by Danny

I think you have sort of an odd understanding of medical research. It's not a field where you can just throw more money at it and watch developments happen faster or better. To take cancer development as an example, it's possible that it's only ultimately curable by nanobots which can intelligently target and eliminate individual cancerous cells. That sort of development will take years of research across multiple fields of science and engineering to come to fruition. Even if you diverted every cent of the national budget into cancer research, it doesn't necessarily mean you'll have a cure any faster. Science doesn't work that way. Heck, many of the most important scientific discoveries happen completely by accident.

Or maybe cancer will never be curable by means of "healthcare." That's why even if the criteria of effectiveness and affordability might seem to you to place good limits on what is "reasonable" today, they do not apply to R&D, because the affordability and effectiveness of R&D is not nearly as easy to measure as are the affordability and effectiveness of, say, taking an aspirin today. In other words, what you're saying here is presupposed in my argument.

But of course there is a genuine balancing side to this that no one will deny -- as more money, innovation, effort, etc. is put toward medical R&D, it becomes more likely there will be further development on the whole. You won't be able to say that you will definitely be able to fix one particular thing, but you will unquestionably be able to come up with more (and more expensive) treatments for something. There's not necessarily an even 1-1 correspondence -- I can't say that 5 units of research will give you 10 units of development -- but if you put a bunch into research, on balance, you're going to come up with more development than if you put basically nothing into research.

Originally Posted by Danny

I really don't understand how an adoption of universal healthcare suddenly makes R&D different somehow. Maybe I'm just not following you correctly.

I don't understand why people keep talking about "universal healthcare" in this thread. I'm certainly not. I'm just talking about "healthcare." I think that taking care of the sick has been turned into a consumer good and therefore it's always going to be hopelessly muddled.

Originally Posted by Danny

Again, I'm not sure I'm understanding your argument correctly, but it seems that the conclusion you're trying to arrive at is that universal healthcare is impossible because "reasonable" can't be defined. But it is quite obviously not impossible, since it's been realized in every other industrialized country on the planet. It's not a question of, "Can we do it?" it's a question of "How?" or "Can we do it better?" And for that, it would be simple enough to draw inspiration from any of the 52 countries that already have it, while adapting it to our own needs. If I'm following you correctly, it sounds like you're using Aristotelian physics to prove that human flight is impossible, but you're a century or so too late.

Just in case it's not already clear: I'm not making an argument about "universal healthcare." Go back and read what I've written; it's just not there. In fact, I can point you to a relatively similar argument from Paul Krugman, who is himself an apologist in favor of "universal healthcare." I did mention "universal healthcare" in order to say that this is a term that just about everybody uses, but I didn't make much of an argument about it.

Originally Posted by Danny

Healthcare is not R&D. They're two distinct fields and they have to be treated as such.

But they overlap in such a way that they have to be discussed together here, because "reasonable" is being defined as a range relative to contemporary R&D. It would be like saying "x = y -1" but not talking about y.

Originally Posted by Danny

In the case of research, "good" simply means "sufficient." When the researchers have enough money to pursue the avenues they believe are promising, that's good enough. When they don't have enough money to conduct an important study which has a high likelihood of yielding results, that's not good enough. I can't tell you where that line is because I'm not a researcher, but that doesn't mean the line doesn't exist, or even that it's particularly fuzzy.

There can always be more researchers, more research, more funding. The more you've got, the more promising leads you can find, and the more leads you can follow up on. The more extensive the medical culture becomes, the more problems and possibilities it discovers. "Sufficient" is not a word that has a content here other than "the status quo." And of course you've already got this question to deal with: Why sustain the current level of R&D at all? Isn't it enough that we are able to cure 99% of the diseases and conditions that have killed people throughout history, excepting old age? Presumably it's because we apparently haven't got enough healthcare yet.

[Yoda_me07]

well here in australia,


'medicare health care'
basically means that: (heck i'll just give you the info on the page)

Medicare ensures that all Australians have access to free or low-cost medical, optometrical and hospital care while being free to choose private health services and in special circumstances allied health services.

Medicare provides access to:

* free treatment as a public (Medicare) patient in a public hospital
* free or subsidised treatment by practitioners such as doctors, including specialists, participating optometrists or dentists (specified services only)

Australia’s public hospital system is jointly funded by the Australian Government and state and territory governments and is administered by state and territory health departments.

Medicare enrolments and medical benefit payments are administered by Medicare Australia through its network of Medicare offices and other information claiming services.

there's also the

Through the Pharmaceutical Benefits Scheme (PBS), the Australian Government makes a range of necessary prescription medicines available at affordable prices to all Australian residents and those overseas visitors eligible under Reciprocal Health Care Agreements.

Australian residents and visitors from countries with Reciprocal Health Care Agreements with Australia are entitled to subsidised medicines under the PBS. Some clients CentrelinkExternal link and the Department of Veterans' AffairsExternal link are entitled to a further reduced concessional rate. PBS Safety Net provides financial assistance to individuals and families who use a lot of medicines in a calendar year.

The Department of Health and AgeingExternal link is responsible for program policy development and overall management of the PBS including administration of the Pharmaceutical Benefits ScheduleExternal link. Similarly the Department of Veterans' Affairs is responsible for the overall policy for the Repatriation Pharmaceutical Benefits Scheme (RPBS).

Under the PBS and RPBS Medicare Australia makes payments to pharmacists to subsidise medicines on the Pharmaceutical Benefits Schedule. Medicare Australia also makes payments to pharmacists for other PBS related issues including the issue of Safety Net cards, payments in support of rural or remote pharmacies and for the supply of medicines to Aboriginal Medical Services and for the Emergency Drug (Doctor's Bag) system.

Authority prescription approvals are administered by Medicare Australia for prescriptions for which the Pharmaceutical Benefits Advisory Committee limits supply in specified circumstances. We also administer the approval of pharmacists to supply medicines under the PBS, the approval of health care providers in remote areas where there are no adequate pharmacy services and the approval of hospitals to supply PBS medicines to their patients.