<p>The thing with Drs these days is that more and more of them work for hospitals and those hospitals metricize them by volume, ie, how many patients they discharge. </p>
<p>There’s so much anger at the insurers. I don’t think many people understand the huge cost of hospitals. Sort of like universities with the huge costs of administrators v professors.</p>
<p>There’s a good pie chart from Kaiser on this but I’m too busy to hunt it down.</p>
<p>The interesting thing about health care is that people feel so passionately that this player is the bad guy or that player is at fault. It’s extraordinarily complex.</p>
<p>This whole idea of the unfeeling doctor who has no time for the patient, is sort of a cliche. The docs themselves are really just employees within the system and if they are rushing there may be a reason besides they aren’t very nice.</p>
<p>Why would an NP or PA be nicer than an MD anyway?</p>
<p>I think the NP and PA thing is probably good just like engineering techs and paralegals are good.</p>
<p>Those in the high end of medical research will tell you that part of why Canada can operate as they do, is because the US is provides the leading edge that they do not. Not a lot of bragging about their systems by the Canadians, Australians and British i see at Memorial Sloan Kettering.</p>
<p>mini - I think hospice care and palliative-only care is a great solution. Unfortunately, what I saw in my Dad’s nursing home was far more “do whatever is possible with no regard for cost or quality of life” than the hospice/palliative only route. I actually thought it was cruel to the patients. Some of the problem is fear of death, but I also think doctors/instituions get compensted for procedures/tests/treatments. Certainly death panels and health care rationing are very tough topics, but I was horrified by the extreme measures being taken to give severe dementia, very late stage kidney or heart disease, etc. patients two more weeks or months of life! The USA has got to figure out why we spend twice what our peers do!</p>
<p>Your dad may not have been on hospice care. He (and his family) would have to specifically elect it. Medicare provides it as an option, but doesn’t require it (doctors and hospitals have a very strong lobby!)</p>
<p>Still, even voluntarily, Medicare-paid hospice is growing at a very, very rapid rate. </p>
<p>And, yes, the insurers are the ultimate bad guy. They have no rational interest in health.</p>
<p>Hospice care was great for my grandmother. Both my grandparents were killed in hospitals on purpose. The families saved money. I think overall health care costs were lowered because they were killed.</p>
<p>What do you mean that your parents were “killed on purpose.”</p>
<p>emilybee –</p>
<p>The cost of living calculators take into account property tax when they rank cities. I would consider that I live in a fairly high cost of living area. You mention your home is worth $260K. I’m assuming this is a single family home. In our area, the least expensive properties sell for at least $400K and those are condos. The median price of a home is $700K. In places like Palo Alto, CA I believe the median price of a home is around $1M. It’s also around $1M in Darien, DT. I agree that $8K is a very high tax rate, but the primary thing that influences your cost of living is how much it will cost to buy or rent a house.</p>
<p>Aqua, yes, I understand all that. I was simply pointing out why that poster believes she is living in a high cost area especially considering where she was coming from where a similarly priced home likely paid a 1/4 of the property taxes and where for the same price a home would likely be triple in size. Also, wages are pretty low in lots of places in upstate NY but taxes are very high in all of NYS. </p>
<p>For the record, I don’t live in western NY but an area of the state where salaries are considerably higher. </p>
<p>NY also doesn’t assess like other states when it comes to property taxes. It is based more on sq. footage than price so, for example, a falling down 2000 sq. foot dump will pay the same in property tax as a brand new home/remodeled of the same size worth a lot more. </p>
<p>It’s especially difficult for older people who bought their homes 30 or 40 years ago and whose home values have barely risen in that time, but their property taxes just keep going up and up.</p>
<p>Aquamarinesea, they were killed. They were going to die eventually. My grandfather had bone cancer and he developed pneumonia. The pneumonia was treatable And my grandmother said to the doctors not to treat it. So the doctors didn’t. The morphine was turned up instead. And my grandfather died. He wasn’t going to die at that time. </p>
<p>I think this decision bothered my grandmother the rest of her life.</p>
<p>My grandmother had heart problems and was retaining water. She probably had a couple of months to live. Who knows? She told her doctor she wanted to kill herself. </p>
<p>These decisions saved money. Maybe suffering was lessened. My grandfather was fighting. He was unconscious, but be was squirming.
A doctor would know more than me. On the face
of it, I did not like what I saw.</p>
<p>Needless to say, I hear about “end-of-life” decisions every night, when my wife comes home from work. There is no right way, no formulaic decision. The best we can do is create a situation where a loved one has maximum dignity, and maximum freedom to make decisions; when that isn’t possible, then his or her loved ones do. The wonderful thing about hospice is that it both saves money and enhances quality-of-life.</p>
<p>“These decisions saved money. Maybe suffering was lessened. My grandfather was fighting. He was unconscious, but be was squirming.
A doctor would know more than me. On the face
of it, I did not like what I saw.”</p>
<p>It would be good if the spouse knows the others wishes. One can do a living will all they want, but a direct understanding of what the other wants is critical.</p>
<p>When I heard how my dear father in law suffered the last couple of weeks of his life, I knew for me that I’d prefer that they turn up the morphine quicker (which does hasten death). If I was quite elderly, terminal, and in terrible pain, why would I want to hang onto every second of life to suffer, and make my family suffer, watching me? Perhaps your grandfather was fighting because how do you override that when you are unconscious? It is hard to tell what someone might have wanted if they haven’t talked about it, and unfortunately when that choice has to be made, it might be too late for discussion.</p>
<p>I’ve got strict instructions from my mom and dad - they also have a living will - and I have the medical power of attorney and my sister has the legal power of attorney - not sure exactly what either of them are actually called - but we both have the legal docs explaining it all and if either of us are unavailable we can assume the others responsibility. </p>
<p>I don’t think my grandfather wanted to die. I am pretty sure he didn’t; although he was in pain. Pretty pretty sure. </p>
<p>My grandfather lived a lot longer than expected when the morphine was turned up. I am talking many extra days. He may have been given water at first. Maybe that prolonged things but he wouldn’t die.</p>
<p>Before I fainted and went to the hospital, I was so stressed. When I picked myself up off the floor, I had never felt that good in my life. My wife was screaming. I asked her, “What are you yelling for? I feel great”.</p>
<p>Mini, how does your wife handle the stress of her job? She comes home and beats the crap out of you. Right?</p>
<p>But really, how does she handle the stress?</p>