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Don't treat the old and unhealthy, say doctors

Such a dry sense of humor those Brits have.

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=EDWY0HBPMWGUPQFIQMFCFF4AVCBQYIV0?xml=/news/2008/01/27/nhs127.xml

Don't treat the old and unhealthy, say doctors

By Laura Donnelly, Health Correspondent
Last Updated: 2:09am GMT 28/01/2008

Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives.
# Have your say: Should lifestyle play a role in deciding who gets NHS treatment?

Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.

Smoker - Don't treat the old and unhealthy, say doctors
£1.7 billion is spent treating diseases caused by smoking, such as lung cancer and emphysema

Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state.

The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "out­rageous" and "disgraceful".

About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt.

Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.
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The Government announced plans last week to offer fat people cash incentives to diet and exercise as part of a desperate strategy to steer Britain off a course that will otherwise see half the population dangerously overweight by 2050.

Obesity costs the British taxpayer £7 billion a year. Overweight people are more likely to contract diabetes, cancer and heart disease, and to require replacement joints or stomach-stapling operations.

Meanwhile, £1.7 billion is spent treating diseases caused by smoking, such as lung cancer, bronchitis and emphysema, with a similar sum spent by the NHS on alcohol problems. Cases of cirrhosis have tripled over the past decade.

Among the survey of 870 family and hospital doctors, almost 60 per cent said the NHS could not provide full healthcare to everyone and that some individuals should pay for services.

One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements.

Tony Calland, chairman of the BMA's ethics committee, said it would be "outrageous" to limit care on age grounds. Age Concern called the doctors' views "disgraceful".

Gordon Brown promised this month that a new NHS constitution would set out people's "responsibilities" as well as their rights, a move interpreted as meaning restric­tions on patients who bring health problems on themselves. The only sanction threatened so far, however, is to send patients to the bottom of the waiting list if they miss appointments.

The survey found that medical professionals wanted to go much further in denying care to patients who do not look after their bodies.

Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant, while one in five said taxpayers should not pay for "social abortions" and fertility treatment.

Paul Mason, a GP in Portland, Dorset, said there were good clinical reasons for denying surgery to some patients. "The issue is: how much responsibility do people take for their health?" he said.

"If an alcoholic is going to drink themselves to death then that is really sad, but if he gets the liver transplant that is denied to someone else who could have got the chance of life then that is a tragedy." He said the case of George Best, who drank himself to death in 2005, three years after a liver transplant, had damaged the argument that drinkers deserved a second chance.

However, Roger Williams, who carried out the 2002 transplant on the former footballer, said doctors could never be sure if an alcoholic would return to drinking, although most would expect a detailed psychological assessment of patients, who would be required to abstain for six months before surgery.

Prof Williams said: "Less than five per cent of alcoholics who have a transplant return to serious drinking. George was one of them. It is actually a pretty successful rate. I think the judgment these doctors are making is nothing to do with the clinical reasons for limiting such operations and purely a moral decision."

Katherine Murphy, from the Patients' Association, said it would be wrong to deny treatment because of a "lifestyle" factor. "The decision taken by the doctor has to be the best clinical one, and it has to be taken individually. It is morally wrong to deny care on any other grounds," she said.

Responding to the survey's findings on the treatment of the elderly, Dr Calland, of the BMA, said: "If a patient of 90 needs a hip operation they should get one. Yes, they might peg out any time, but it's not our job to play God."

created by charlatan on Jan 28, 2008 at 07:50:21 am     Comments: 46

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Comments ... #

Interesting question: Is it right for the government to be enabling poor lifestyle choices?

Shouldn't we instead be incentivizing good health. Provide universal health care to the healthy in this country and just watch how crowded the jogging trails get.

posted by thetoledowire_com on Jan 28, 2008 at 10:58:21 am     #



Shouldn't we instead be incentivizing good health. Provide universal health care to the healthy in this country and just watch how crowded the jogging trails get.

1. Good health is the incentive for taking responsibility for yourself and living clean.

2. People that are living a healthy lifestyle are the ones that need health care coverage provided to them because they get the lowest insurance rates - just for that reason (low risk factor).

posted by FatBabe44 on Jan 28, 2008 at 11:34:07 am     #



Shouldn't we instead be incentivizing good health. Provide universal health care to the healthy in this country and just watch how crowded the jogging trails get.

1. Good health is the incentive for taking responsibility for yourself and living clean.

2. People that are living a healthy lifestyle are the ones that dont need health care coverage provided to them because they get the lowest insurance rates - just for that reason (low risk factor).

posted by FatBabe44 on Jan 28, 2008 at 11:35:19 am     #



I'm thinking of my 81 year old neighbor, placed in a nursing home last week. He was a heavy smoker all his life in spite of repeated warnings from his doctor that he has emphysema. He has had several small strokes in the past weeks, and has a raging kidney infection from a hospital catheter. The infection is destroying his kidneys and is unresponsive to all but the most expensive antiobiotics. He has no quality of life, doesn't know where he is, can't feed himself or even turn over in bed. He does sit up in a wheelchair during the day. He is on medicare and receiving every medical test/treatment including rehab therapy! His family has medical power of attorney. In spite of their request to limit treatment and just keep him comfortable, there seems to be a disconnet between their wishes and the nursing home staff. They are new at this and I expect if Dad doesn't die soon any way they will get a handle on it. They are educated and responsible people. But who is responsible for what here? Dad, of course for smoking Camels for 40 years. But what about the hospital that gave him a lethal infection be cause of poor catheter management practices? What about the nursing home that repeatedley lines him up for rehab in the hallway for hours that he is absolutely unable to participate in? What about the doctor that ordered it?

posted by holland on Jan 28, 2008 at 11:53:33 am     #



1. Good health is the incentive for taking responsibility for yourself and living clean.

2. People that are living a healthy lifestyle are the ones that dont need health care coverage provided to them because they get the lowest insurance rates - just for that reason (low risk factor).

A strong healthy populous is good for our country, while having an overweight, boozing, smoking population harms us as a nation. With obesity soaring in the past 20 years (just check the recent ToledoTalk Obesity Map post), incentives 1 and 2 listed above are clearly not enough.

I propose full health care coverage for those Americans meeting certain good health guidelines while those who choose to live unhealthy lifestyles can fend for themselves in the single payer system. The added incentive to live healthy would not only slash costs, but would mean less sick people to begin with. Providing free health care to those with poor lifestyles amounts to subsiding and enabling their bad behavior, or put more simply, paying people to be sick. So the alternative system I have just outlined is both economically attractive and morally just.

posted by thetoledowire_com on Jan 28, 2008 at 01:28:49 pm     #



Uh, the math is bad here thetoledowire. People with no insurance, avoid doctors generally because they can't afford to go. They receive no preventative care. Think high blood pressure as just one example. The uninsured wait until they are much sicker to get treatment. Hospitals build into their rates the costs they face for treating individuals who wont be able to pay because they don't have insurance. Who pays these costs? The insured do. The insured are paying for the uninsured. As a result the insured are paying more because if the uninsured went for treatment sooner treatment costs would be reduced. I'll tell you this, the health insurance industry just loves misinformed people like you. They want to only insure the healthy and pay no claims - and let you unknowingly subsidise the uninsured. Way to go!

posted by holland on Jan 28, 2008 at 02:05:04 pm     #



That is a good point, Holland, and one that I trumpet often but let's take a look at our pool of uninsured people currently. These are people who can't afford insurance. Some of them are healthy, some are not, so, by giving the health ones free insurance (and encouraging the unhealthy ones to get in shape), we have not added anyone to the prevention avoiding uninsured group. Rather we have provided free preventative care to some of them while encouraging others to take the most important preventative step, adopting a healthy lifestyle. If the insured are going to cover the uninsured anyway, it's better to pay the medical bills of a group of uninsured athletes vs. a group of beer drinking couch potatoes.

posted by thetoledowire_com on Jan 28, 2008 at 02:47:22 pm     #



toledowire - providing free "healthcare" (ie insurance) or even free medical care is not the government's responsibility.

I'm curious how would you determine who gets what and how much?

For Example:
Sally wants a bunionectomy because she has a little pain in her foot sometimes and besides, her feet look terrible in sandals.

1. Do you feel good about more money taken out of your paycheck to pay for that just because she's been a good girl and ate her broccoli and no fast food?

2. Joe is a very strapping 45 year old that has led what he thinks is a healthy lifestyle. Well, at least thats how it appears to the government who checks his blood every six months so he can get his free healthcare. What Joe didn't tell anyone was that he like to drink heavily and smoked pot and crack. Now he has lung cancer and brain anuerisms. His local government lab didn't catch that earlier because checking his blood for booze and drugs would be an invasion of privacy.

Think real hard about all the scenarios before you decide

posted by FatBabe44 on Jan 28, 2008 at 03:07:22 pm     #



When you consider that government spending accounts for more than 60% of the median individual income, I have a hard time being convinced by arguments that the government should supply something (whatever it may be) to people because they "can't afford it".

More than half of that 60% of median individual income comes from that last 50 issues that were fought about government supplying things to people.

As soon as the government starts supplying healthcare, there will be even MORE things that people will not be able to afford.

So where does it stop? Why doesn't the discussion ever go like this:

Hmmm, these poeple can't afford healthcare. So if we cut the size of the federal government by 30%, they will be able to afford it.

posted by babbleman on Jan 28, 2008 at 03:12:45 pm     #



Instead, the discussion is always, hmmm, these people can't afford healthcare so lets increase government by 5% to pay it for them. Before you know it, government is 60% of your income and you haven't yet even scratched the surface of all the future things that government will "need" to do - especially because at this point, no one can afford anything because they are working more than half the week just to support the government.

posted by babbleman on Jan 28, 2008 at 03:17:01 pm     #



Suppose you are like my Mom was, non-smoker, 5', 95lbs. and blood pressure an astronmical 210/190! She worked hard as a cafeteria worker, plenty of physical exercise. So was her blood pressure her fault? Insurance or no insurance? Deal or No Deal? It's an absurd premise.

Any thoughts on why someone can't afford insurance if it is not employer provided? Take my premium for instance, $840 a month. Could you come up with that?

posted by holland on Jan 28, 2008 at 03:17:34 pm     #



I apologize, I haven't yet finalized the wording of legislation having just come up with this idea just this morning. However it is an important question who gets what and how much? However, this isn't exactly a question strictly for government subsidized health care. Who ever decides this? Regardless if it is a public bureaucracy beholden to the taxpayers or a private bureaucracy beholden to the shareholders, someone will have to decide.

As for the question on Joe, I have doubts that a boozing crack addict will ever appear to be in good shape but even though it's extreme your illustration raises a larger point. Obviously some people will abuse the system. However again, this problem would not be unique to this system. People lie on their insurance applications frequently for private insurance because that means a lower rate. If some one claims to be a nonsmoker on a form but actually has a pack a day habit, that will always be hard to prove.

Now with all that said, this concept is not necessarily government operated health care. This concept could go public or private. You could set up a government health insurance or you could or you could subsidize private insurance for healthy people, the latter probably being the easier sell on the public and the medical and insurance industries.

posted by thetoledowire_com on Jan 28, 2008 at 03:31:52 pm     #



And Wanda the Good Witch will wave her sparkly wand and it will be wonderful in the land of Oz where liberals are living.

posted by FatBabe44 on Jan 28, 2008 at 03:42:10 pm     #



>>Take my premium for instance, $840 a month. Could you come up with that?>>

Sure, here's how holland. Eliminate the following from the federal government. The $ next to each will be the monthly savings to the average taxpayer:

$227 Unemployment and welfare
$414 Medicare and medicaid
$72 Agriculture and education
$362 Social security
$1,074 Total

Take the remaining $234 per month and save it for 40 years at the NYSE's 80 year average return of 5.9% and you will have $478,000 to retire on.

Not everyone will do that you say? Well you are probably right - however, for those who don't, who is going to do it for them?

The bottomline is easy: everyone HAS to take care of themselves - because there is no other alternative.

posted by babbleman on Jan 28, 2008 at 03:58:51 pm     #



Oh babbleman, just put a sock in it will ya? What tripe! How can you lump in things such as roads and airports and all the other goverment costs for the necessary economic items every one utilizes, including corporations. Which costs do you propose eliminating to reduce that 60%? Just those that you feel are too warm and fuzzy?

posted by holland on Jan 28, 2008 at 04:01:11 pm     #



holland, maybe you missed my post above. I am not suggesting the federal government disappear. I am suggesting that those things that are done for our individual "welfare and security" be eliminated so that we can manage that ourselves because there is no sustainable way for it to happen otherwise.

My point is, the fact that is is not sustainable is exactly what you are seeing now. The reason you can't afford healthcare is precisely because you are already being so heavily "taken care" of.

posted by babbleman on Jan 28, 2008 at 04:16:38 pm     #



btw, none of my proposed government cuts include national security, infrastructure, justice or administration.

posted by babbleman on Jan 28, 2008 at 04:18:16 pm     #



I failed to mention that the $840.00 is paid by my employer (which happens in this case to be myself). If I wasn't the owner of a small company which gets group coverage I could get no coverage at all in the private market. I am unisurable becaue of high blood pressure, though treated and under control with medication. I have no other health problems. But in the health insurance industry's eyes I am for all practical purposes uninsurable in the private market. A $10,000 deductible policy starts at $2,200 month.

posted by holland on Jan 28, 2008 at 04:33:51 pm     #



>>If I wasn't the owner of a small company which gets group coverage...>>

What about if you were an employee of a small company with group coverage? Wouldn't that work too?

posted by babbleman on Jan 28, 2008 at 04:51:00 pm     #



I AM a salaried employee of the company I own. I don't understand your question. Our company, having experienced a 50% cost increase for health care since 2002, at one point considered giving all employees a raise equivilant to what the company was paying for their premiums.
We never made that offer when we were informed of the true cost these employees would face in getting coverage in the private market. Some could obtain no insurance at all at any cost due to pre-existing conditions. Insurance companies wont underwrite for asthma, high blood pressure, bad backs, any one who has ever had a breast biopsy (even if the findings were benign) etc.,etc.. What I am telling you is that there is no way the average wage earner who is not in perfect health or who is over the age of 55 can get health insurance in the private market. If you dumped everyone today who is covered by employer sponsored health care into the open market there would be an astronomical increase in the total number of uninsured who would have no access to health care. Any one over the age of 55 could be one chest pain away from the decision of dying or losing the house and any savings.

posted by holland on Jan 28, 2008 at 05:27:39 pm     #



Any one over the age of 55 could be one chest pain away from the decision of dying or losing the house and any savings"

I think it is agreed on both sides of the issue that there is a problem today with people not being able to get insurance when they need it. However, the hospitals do NOT refuse treatment for someone coming to the ER with chest pain or other life-threatening conditions. Not to mention if I had a choice over dying or losing my house...it would be losing my house. I can always start over if I lose my house.

Anyway, back to the fact that we all agree there's a problem. What we don't agree on is that the government should be taking more money away from everyone to pay for it.

You want to know what the truth is? If the churches were doing what they are SUPPOSED to be doing (helping the poor, the orphans, widows) they'd be subsidizing healthcare. BUT, the churches can't afford it because not enough people are giving their tithes and offerings. That's one of the biggest intentions of tithes and offerings.

We Christians have failed at what we were instructed to do. Well, not all, but most.

posted by FatBabe44 on Jan 28, 2008 at 05:51:01 pm     #



Ok, holland, I see what you are saying. We are talking about totally different things, I guess. I am talking about the economic feasibility of the government continuing to pay for more and more individual welfare (ie, socialized medicine in any flavor) based on the argument that people "can't afford" things when, in fact, a large part of the would-be discretionary income that could make these things affordable is being sucked up by the all the previous welfare proposals. Obviously, this is not a sustainable trend, and I layed out the specific monthly costs to the average taxpayer to illustrate.

You, on the other hand, are talking about dumping "everyone today who is covered by employer sponsored health care into the open market". Maybe I missed something, but is someone suggesting that everyone be dumped?

posted by babbleman on Jan 28, 2008 at 05:52:10 pm     #



>>We Christians have failed at what we were instructed to do. Well, not all, but most.>>

FatBabe - I am with you completely until this last sentence.

I don't believe that private (ie, voluntary) charitable contributors are to blame (whether it be via church, community or otherwise). I think the ability to be privately charitable is reduced proportionately by the increase in public charity (taxes). With $1,100 per month taken for public charity by the (federal only) government - what is left to give to the church (much less the ability to help your parents and other relatives which is another important source that is diminished - family support)? So, in effect, both family and church support are deteriorated.

What's more, as each generation goes by having their ability to privately give restricted by taxes, the culture of private charity (ie, watching your parents give, wanting to give yourself, feeling the responsibility to give) is slowly eliminated from society.

posted by babbleman on Jan 28, 2008 at 06:06:18 pm     #



And to be fair, public charity (taxation for welfare) is not lost to thin air. There are no doubt many people helped by it.

However, I give what I think is alot of money to charity and when I do I am extremely particular about who I give to. Their mission, their leadership, and their operational efficiency I look at closely.

On the other hand, when the government takes my money and decides who they are going to give it to, their decision is inherently driven by what will preserve their power (ie, what will get them the most votes with it).

Those are two very different models of resource allocation and I can categorically gaurantee that there is no way that the latter can result in being just, compassionate or sustainable - all things that its supporters promise but have no way to deliver.

posted by babbleman on Jan 28, 2008 at 06:20:52 pm     #



"The bottomline is easy: everyone HAS to take care of themselves - because there is no other alternative."

How do you propose everyone does that today, in the current health care environment? It's impossible to save at rate that would keep up with escalating costs to fund your own catastrophic care. It's tough enough to get the kids their vaccinations or preventative dental care. If you don't have insurance and make over a certain amount there isn't any program that helps. The currrent health care system is sucking the life out of the economy. BTW, try making an appointment to see any doctor and say you don't have insurance. You will get turned down. Flat.

posted by holland on Jan 28, 2008 at 06:53:50 pm     #



Most doctors would deny treatment to themselves then.

Why is it that people in great shape and "perfect" health rarely work in the health industry?

posted by charlatan on Jan 28, 2008 at 10:11:37 pm     #



Hey holland - I'm guessing that your neighbor was prescribed physical rehabilitation in an attempt for Medicare to cover the stay.

Medicare only covers "skilled" nursing facility stays...not general long term care. If your neighbor didn't have those hours of rehab and the other nursing care, Medicare would most likely no longer authorize coverage for his stay.

If the family's wishes for minimal daily care were being followed, they'd have to find a way to foot the bill themselves.

Medicare only covers services in a nursing home if certain criteria are met (some combination of physical rehabilitation hours and/or services that must be provided/supervised by an RN).

posted by mom2 on Jan 28, 2008 at 11:47:54 pm     #



Well, that explains that. Thank You! I'll pass it along to the family. They don't have the means to finance Dad's stay. Dad doesn't have the means to finance Dad's stay. His Teamster's pension and Social Security apparently isn't sufficient. What do families do in these circumstances?

posted by holland on Jan 29, 2008 at 12:56:26 pm     #



If Medicare isn't paying for the stay and you can't afford private pay, there are basically 2 options:

1) Qualify for Medicaid. Medicaid will pay for long term care for those who qualify. (He'll likely have to pay for the care out of the assets he currently owns until he becomes indigent and qualifies for Medicaid - there's a spend-down formula that is used. The family can investigate the particulars of that, if they are interested.)

2) He can go back to his home or the home of a family member.

Not pretty, but those are the options for long term care. (Unless you have a long term care policy or can afford to pay out of your own pocket.)

Medicare and health insurance only cover skilled stays (as referenced above - nursing and/or physical rehab hours), and even then there are limitations on the total number of days you can have covered.

If your stay isn't skilled or you exhaust your Medicare/insurance days, your options are basically limited to what I mentioned above: private pay, long term care policy, qualify for Medicaid, or move back home.

posted by mom2 on Jan 29, 2008 at 09:47:47 pm     #



Holland - have the family get an Elder Care Lawyer. My family just went through this as well. There are lawyers specializing in just this thing. They are not cheap, but it was well worth the expense.

posted by SensorG on Jan 30, 2008 at 11:34:51 am     #



<<<"The bottomline is easy: everyone HAS to take care of themselves - because there is no other alternative.">>>

holland said: How do you propose everyone does that today, in the current health care environment? It's impossible to save at rate that would keep up with escalating costs to fund your own catastrophic care.

In My Humble Opinion -
Taking care of yourself starts with how you treat your body, not necessarily how much money you have. That's what I've been trying to say. Our American fast-food lifestyles have GOT to change if we want a future. The rate of child obesity is pretty well known and talked about on tv, so we all know what needs to be done to start with:

Eat your vegetables.
Don't eat fast food or prepackaged foods.
Don't drink excessively.
Don't smoke at all.
Don't do drugs.
Don't have unprotected sex if your non-monogamous
Get exercise.
Take care of your mind as well.

Everybody knows that exercise and eating right give you the best chance of remaining healthy. It's just common sense.

Granted there are people that are just genetically prone to diseases. There's nothing one can do about that but get tested, pray, and seek care. I think it's also up to the medical community (hospitals and doctors) to be expected to offer their best care to the truly needy at either a cut rate or no cost. It wouldn't hurt either if a few of the multi-billion dollar corporations coughed up more for treatment and research.

I haven't even mentioned how the frivolous lawsuits have affected the cost of medical care! Or how about the billions that pharmaceutical companies spend on direct to consumer advertising, and spending sprees selling to doctors' offices.

There is no easy fix. That's why it has to begin at home with each of us.

posted by FatBabe44 on Jan 30, 2008 at 12:26:05 pm     #



Those are good suggestions for healthy living FatBabe44 but I see little in that list that would stave off a torn knee cartilage or arthritis or uterine fibroid tumors or Alzheimers or appendicitis or multiple sclorosis or pneumonia or scoliosis or a torn rotator cuff or glaucoma or...............

Well you get the idea. It ain't all preventable or testable FatBabe44. Your list, while helpful, is smug and smacks of laying guilt on people who just get inexplicably injured or sick with something they could not have tested for much less prevented.

An apple a day does not always keep the doctor away.

posted by holland on Jan 30, 2008 at 01:51:10 pm     #



My post has nothing to do with accidents thanks for the nice opinion on my character though.

Your points are taken, but that wasn't where I was going with my ideas. I'm specifically talking about very preventable medical problems such as; Obesity (me), Type 2 Diabetes, High Blood Pressure, High Cholesterol/blockage of arteries, liver failure from alcoholism, and the many cancers related to smoking(I'm an ex-smoker)...blah blah, blah.

It just seems to me that these are the things that seem to be on the rise today causing us to be so needy of medical care. Thus, the rise of cost of health care coverage.

I don't think I'm smug, but if it "smacks" of laying guilt on people other than those who abuse their bodies, I apologize sincerely. That's not the intention.

posted by FatBabe44 on Jan 30, 2008 at 02:21:58 pm     #



(I'm an ex-smoker)...

-----------------------------------

Ah, that wxplains it.

posted by Darkseid on Jan 30, 2008 at 06:17:34 pm     #



wxplains=explains

posted by Darkseid on Jan 30, 2008 at 06:20:07 pm     #



I just saw on the news they claim to have made great strides toward possibly curing alzheimer's. I'm beginning to think they'll never find one for cancer.

posted by Darkseid on Jan 30, 2008 at 06:21:36 pm     #



As far as cancer, I've read reports that 70-90% are preventable by changing consumer choices and raising industry standards. Alzheimer's sounds like a heavy metal issue... common chelators might help.

Organizations such as the ACS are allegedly astroturf groups.
http://en.wikipedia.org/wiki/American_Cancer_Society#Criticisms

The Chairman of the Cancer Prevention Coalition, Dr. Samuel S. Epstein, believes their priorities are economically motivated, and reflect conflicts of interests with the pharmaceutical industry, the pesticide industry, and the mammography industry.5

Charity Navigator rates the society two of four stars]].6 The society is directed to "eliminating cancer" but has never been "able to state the progress it has made (or is making) toward its goal", one of the Charity Navigator criteria for a good place to make charitable contributions.7

In the past, the ACS has been involved in a few economic scandals, none of which indicated systemic abuse. In 2000, Dan Wiant, an administrative officer, was accused of embezzling $7 million.8 In the 1980s, an employee discovered that a fund-raiser was leading a $4 million tax fraud scheme.9

posted by charlatan on Jan 30, 2008 at 07:44:53 pm     #



Its all well and good that you would choose to face being homeless Fatbabe but there are lots of people for whom that decision would be just as deadly.
Maybe at 35 you could get back on your feet but at 55 or older it could be a hell of a lot harder. Especially without follow up care.

Treatment at an ER might be something that they have to provide, but that doesn't mean you'll get an ounce of follow up because the doctors and specialists don't have to treat you if you can't pay them.
Have you noticed many doctors are asking to be paid up front before you're taken back to the room now?
Can't pay?
No treatment for you.
Without the follow up care the money spent at the ER is basically a waste.

Its not so very black and white and unless you've been in the position of trying to figure out how you're going to pay for the $6000 worth of chemo a month for six or tweleve months and make the house payment to keep a roof over you and your children's head, you should maybe not be so very quick to assume it should be an easy choice for everyone.

posted by OhioKat on Jan 31, 2008 at 12:41:20 am     #



OhioKat- maybe if you actually read all of my postings you'd not be so quick to assume that I ever even implied it's all black & white. Sheesh.

Perhaps you have good suggestions or ideas on this subject or do you just wish to rip on one part of mine?

I'm going to assume here that you are for government subsidized health care - as in tax money taken from me (and you) and given to someone else without any approval or say in the matter. I don't know where you stand so correct me if I'm wrong please.

Do you want your tax dollars to pay for some person's chemo treatments for lung cancer that they got from sucking on cigarettes for 40 years? If so, then maybe you will want to pay for me to get a gastric bypass surgery or perhaps for a personal trainer and nutritionist. I can't afford it and my insurance won't pay for it.

Please read all of my postings. K?

posted by FatBabe44 on Jan 31, 2008 at 01:33:01 pm     #



BTW - I haven't been in the position before of making that choice, but I do trust in God for all things and hope that I never have to make that choice. I've had my share of hardship in life and my share of good.

I'm not a cold and calculating hard ass bitch. I'm just an average woman in her 40's without a college degree, that has had to work very hard just to make ends meet. I'm not rich - not even close! My husband and I work very hard for what we do have and don't feel it's right to have even more taken away to pay for someone else's foolishness. We give generously to our church and to local charities. We do what we can with what we have.

posted by FatBabe44 on Jan 31, 2008 at 01:45:14 pm     #



No to "socialized medicine". Yes to Medicare for all. These are two different things.

Do any of the candidates' plans call for the nationalization of hospitals or doctors? If not, are these plans really "socialized medicine"?

posted by Chris99 on Jan 31, 2008 at 02:07:43 pm     #



>>...trying to figure out how you're going to pay for the $6000 worth of chemo...>>

>>Do you want your tax dollars to pay for some person's chemo treatments for lung cancer that they got from sucking on cigarettes for 40 years?>>

This is really the key. OhioKat, the question is not whether or not peoople need help. Nor is it whether or not people that need help should be helped.

The question is what is the best way for people who need help to get help.

For some reason, there is a large swath of the population that takes for granted that it has to be government that takes the resources and then allocates them to provide the help. And then, when someone disagrees as to how the help is best provided, pointing out that there are other ways to solve the problem besides government, they are labeled as being not compassionate and somehow the argument gets twisted around such that it is a matter of if help should be provided.

Its not IF, but HOW.

Compassion is completely and totally irrelevant. With very few exceptions, everyone has the same amount of compassion. Just because someone doesn't want the government to do something doesn't mean they don't want that something done. Conversely, those that want the government to manage everything are not the only compassionate people on the planet. Far from it.

FatBabe, for instance, gives to charity privately, but doesn't trust the government's ability to make good decisions when allocating the resources after they are collected in taxes. And I'm sure she could come up with many examples to back that fear up.

If you are going to give x amount of your own dollars to a needy patient voluntarily, you are going to choose which patients to give the money to on a totally different basis than the government would and it will undoubtedly involve better ethical and practical judgements. The government's only basis for judgement is political whim, which has no alignment whatsover with what any rational person would consider what is "best".

I on the other hand, brought up a very valid concern that, at least in part, government is the reason for the problem in the first place. My point is that the amount of money being taken from us for many other programs that have preceded healthcare is a significant reason why many of us can't afford healthcare (see the monthly $ amounts listed above for various existing welfare / charity / social programs).

posted by babbleman on Jan 31, 2008 at 03:09:34 pm     #



So, for people that understand that government isn't the only answer can then argue that people will not help others voluntarily. That the only way we can get help to everyone is if the government forces the issue.

However, that brings up huge flaws in logic.

To the extent that the government is representational, the government is made up of and represents the wishes of the people that have already been decided as ones who will not help. So if we want a representative government but we don't trust our population, how can government help?

The only logical way out of that problem then becomes less represation in government. The idea here is that the government will only represent the "smarter" people that want to help and those "dumber" people will just have to pay up. Hopefully most will agree that less representation is not a good way to go.

These are the reasons I think that we have no choice but to trust people to do the right thing voluntarily. We HAVE to be able to make it on our own without government.

American government, because of its represantational nature, does not have the built in functionality to allocate charitable resources correctly. And the only way to do it correctly through the government is to throw out the representation and move towards totalitarianism.

Logically, if we choose government, we are gauranteed disaster. If we choose people, we are not gauranteed success, but because we at least have a chance at success, it is the only choice we have. We just have to work it out between ourselves.

posted by babbleman on Jan 31, 2008 at 03:26:48 pm     #



Babbleman, the $ amounts you listed above only include programs you do not like/agree with (seemingly). Why do you feel it's appropriate to not include "national security, infrastructure, justice or administration"?

posted by Chris99 on Jan 31, 2008 at 03:30:58 pm     #



>>Why do you feel it's appropriate to not include "national security, infrastructure, justice or administration"?>>

Good point, Chris.

I'm not an anarchist. I think we have to have a federal government. And I think that it has to provide essential functions to keep our boat afloat. Those functions would be protecting our sovereignty (national security), providing a platform for an efficient economy (infrastructure), sorting out contract disputes and enforcing crime (justice) and changing the lighbulbs at the whitehouse (administration).

I believe that those are the only abosolutely essential functions. The reason I think that is from a practical test: If you pull any one of them, the goverhment would almost immediately collapse.

Any other function you add is fine, but it is not, in my opinion, essential. Take FICA - if you pulled that function out, the government wouldn't collapse. You can argue all day long about the long term effects of not having FICA. For instance, you might convince people that in the long run, unless the federal government saves money for people's retirements people won't do it themselves and the society will fall into poverty and ruin causing the government to collapse. But that is based on all kinds of assumptions that may or may not be true.

Any function that is not essential (one whose absence doesn't cause immediate collapse) is, one way or another, charity for someone. And because of the reasons stated previously, I think that our form of government is completely incapable of managing charity effectively. Its not that I am absolutely opposed to government charity. It is just that I am opposed to our government doing charity because I don't think it is designed to do it right. Totalitarian governments do charity well. The problem there is the inherent instability of power concentrated in one person. I am not advocating totalitarianism, but if I wanted to do charity correctly I would.

Having said all this - don't forget that we have 50 states. Personally, I could care less what they do. So if the fed was made up of essential functions only, we could leave the charity to the states. Some states would do it, some wouldn't. For those that do, some would do it better than others. To be honest, as government jurisdiction moves down the line, I am proportionately less concerned because it means, by definition, that the power is increasingly more distributed.

posted by babbleman on Jan 31, 2008 at 04:00:23 pm     #



Thanks babbleman, I understand where you're coming from. But I don't agree with framing some gov't functions as charity. But to each his own.

posted by Chris99 on Feb 01, 2008 at 10:17:06 am     #