<p>dstark –</p>
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<p>Agreed. I brought this up on another thread that eventually got shut down. We just try avoid talking about politics with them.</p>
<p>Our CPA is VERY far to the right while I lean left. My SIL whom I love dearly is also very far right. We are careful not to discuss issues that will upset either of us, since we have fundamental disagreements about some of these issues and will just never agree.</p>
<p>Actually, since we have MDs, attorneys, teachers and others in our family, we try to avoid politics, medicine, law and education as topics when our family gathers. It keeps things more pleasant for all of us. Every once in a while, we do broach some of these topics but only when everyone is in a VERY calm mood.</p>
<p>Can people really not disagree politely? That speaks to a problem bigger than politics.</p>
<p>Aquamarinesea, that is one way to handle it…</p>
<p>I look at the health care question as How do we want to allocate the country’s resources? </p>
<p>How much of the economy should health care take up? How much do we want to pay for health care and who actually pays? Who should be covered? Should health care be a profit driven business? Who makes the money? How do we pay for research and innovation?</p>
<p>I don’t think the US health care system is efficient, or optimal. I do like reading about people’s experiences in the health care system. Posters have a lot of experience with the health care system.
I think I can learn a lot. I think we can learn a lot. I think the article written in Time Magazine was very informative. Some of the links provided by other posters like
zoosermom and doct and others are interesting too.</p>
<p>Healthcare is so huge and growing of an issue that no one “side” or position will be completely correct in fixing it. Also, no one can know how best to serve the needs of such diverse populations and locations. There has to be a lot less yelling and a lot more listening from all sides. To me, an unwillingless to listen to views with which you don’t agree is problematic. Sometimes you have to listen even when you don’t expect to agree because you may learn something or you may have to compromise or you could find out you were wrong. The ultra-conservative in Wyoming may have an idea that is valuable and helpful, but in ignoring him you may never learn that. Listening doesn’t equal agreement, and healthcare affects every single person so a variety of priorities should be expected.</p>
<p>My H and I have a “politically mixed” marriage. For the most part, it is really healthy to discuss both sides of the issues. I think my kids benefit from knowing there are (at least) two sides to most matters. I feel I have a stronger argument for my view because I am well versed in his. Rarely, though, we just avoid a topic to avoid a disagreement. </p>
<p>I think health care is a very troubling matter. The funding is so bizarre (employer/private/government hybrid), the demographics so overwhelming, the culture so expectant of long and comfortable lives, and the law so complex.</p>
<p>Have to look where the biggest least effective expenses are–end of life care. And nobody is willing to go there. I may not be willing to go there. But it’s easily the biggest single most wasteful spending.</p>
<p>[The</a> Crushing Cost of Health Care - WSJ.com](<a href=“The Crushing Cost of Health Care - WSJ”>The Crushing Cost of Health Care - WSJ)</p>
<p>Whether or not people disagree politely sometimes depends on the topic and each party’s connection to it. There is an emotional component to some arguments, particularly abortion, embryonic stem cells, “rationing,” gun rights, gun control, right to die, social services, etc. One has to be ready to handle the emotional component of these issues as well as the “facts.” </p>
<p>Many times, I and others are not in the mood to argue or even discuss issues that we feel people are already firmly decided about, as it does not appear fruitful. If someone brings it up, I try to get a sense of the “temperature” in the setting to decide whether it is something that would get an honest and robust discussion or just wants rubber stamp approval and proceed based on my sense of the setting. I find debates on things in which I do not have much power to change the underlying problem/issue mostly tiring and frustrating. I try to limit engagement in these.</p>
<p>H & I also have a politically mixed marriage–he leans right, I lean left. We have been pretty happy over our many years together and agree to disagree about many issues, but unite in others.</p>
<p>The culture we have can’t be overlooked–the public has been taught the necessity of certain tests and have grown to expect them even though the science doesn’t support some of them. It’s hard to change the tide.</p>
<p>The homeless and mentally ill also take a huge chunk out of medical care, at least in our state. There are about 100 people in our state that are responsible for about 10% of the ambulance and 911 calls, all homeless and/or mentally ill. Many of these problems are interconnected. The solutions will have to be interconnected to and adequate resources need to be devoted to the problems.</p>
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My husband and I are the same way. Although we have sort of mellowed each other a little bit on certain issues.</p>
<p>Gouf, you make a good point. And from my own experience with elderly parents, sometimes they don’t want to hear that no amount of medical care will make them completely comfortable beyond a certain point.</p>
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That is an absolutely amazing figure. I think that like education for kids from deeply dysfunctional homes, the hard truth is that there is no fix unless the state takes custody of the people in question. And that is a hard, hard thing to do.</p>
<p>In California, illegal immigrants are a huge drain on the healthcare system. </p>
<p>But I agree that end of life care is something that needs to be addressed. The problem is that doctors cannot know in many cases when the end of life is near. Age alone cannot be a criteria. </p>
<p>The other thing that needs to be addressed is personal responsibility for health. There have to be some penalties for those who do nothing to curb their bad health habits. I shouldn’t pay the same premium for my insurance as a smoker, an alcoholic or someone who is severly obese. Therefore, I don’t like any one-size-fits-all system.</p>
<p>Barron’s, that is a great article. If it was my kid, I would want to save him.</p>
<p>I attended a panel by ICU docs around the world about end of life care and how it is handled, including the agonizing decisions the medical team had to discuss with the families. End of life care continues to be a BIG, wrenching and costly issue worldwide.</p>
<p>For many health conditions, it can be very tough to KNOW when the patient is appropriate for hospice or palliative care or will still be around and living in 10 years. For COPD, this is especially true. I have corresponded with many people who have defied all medical expectations for their longeivity and have used supplemental O2 with their lung function at 20s% or less of predicted.</p>
<p>Just found the article I’ve been carrying around for months (since October 2012)–in HI, the 50 top callers for 911 in our state made 1199 calls in the 1st 9 months of 2012 and were projected to reach 1600 calls by the end of the year. They cost the system about $7 million/year ($140,000/patient). 72% have chronic medical issues, 36% are homeless, 36% are mentally ill, 22% are addicted to alcohol or drugs. Our state devoted only $150,000 for a pilot project to have off-duty community paramedics check up on these 50 to see how they’re doing and hopefully reduce the 911 calls. That really seems way too little to me.</p>
<p>“There are about 100 people in our state that are responsible for about 10% of the ambulance and 911 calls, all homeless and/or mentally ill.”</p>
<p>So in my former professional work, we started a project in Seattle called the 1811 Project. You can look it up on-line. There was a relatively small list of homeless folks who cost everyone a huge amount of money - up to $2 million each per year - in health care, emergency rooms, jails and prisons, etc., etc. So a building was rehabbed, and ready to receive these homeless people. It is a so-called “wet” facility - folks can drink as much as they want - in their rooms - and no one is going to check their rooms for drugs.</p>
<p>Then social workers took the list of the top 100, and went about finding them (there was room for 75). There was a belief that the homeless wouldn’t accept housing. Well, they were full by the time they got to number 78. (There is one area in the building where sleep in what could be described as cubbies, with low walls - because some folks were afraid to sleep in totally enclosed spaces alone. No one had to go to alcoholism or drug treatment (on average, each person had already been EIGHTEEEN times.) A consulting nurse was there daily, especially between the hours of 5 -8 p.m. (the prime time these folks would have gone to the hospital.) A social worker helped residents meet medical and mental health appointments (the latter often on site.) Residents PAY one-third of their income for the housing (many are on SSI).</p>
<p>After one year, ER visits dropped by 2/3rds, medical expenses dropped by half (it would have been more, except that there was pent-up demand for services). Jail stays dropped by more than half. Drinking dropped 55% (without treatment - about 6-8 percent went to treatment.) About 30% became employed (mostly part-time.)</p>
<p>Yes, it was expensive to set up, but much less expensive that what these same people cost us on the streets. Oh, and the neighbors are very happy - no more whiskey bottles or dirty needles by their shops and hotels.</p>
<p>There are doctors here who won’t take Medicare patients or limit how many they take. The first quesition one often gets when making an appointment with any doctor’s is office is what insurance you have.</p>
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<p>DocT - I’m not sure what kind of doctor you are, but the above statement is absolutely not true. </p>
<p>Here are a few other topics not necessarily directly mentioned in the article:</p>
<p>Overall cost of care for someone who goes to an independent medical group is 30% less than for someone going to an affiliated office.</p>
<p>Dr. salaries peaked in the 70s and have been declining since. ALL of the growth in healthcare cost has been in regulation to feed the profit machines of large healthcare organizations and suppliers - hospitals, pharmaceutical companies, medical equipment, insurance companies, and the various hangers-on in the industry.</p>
<p>Unfortunately, we are living this. My wife is an NP who works 70 hours/week and is on call nights. Last year she cleared about $15k.</p>
<p>The first quesition one often gets when making an appointment with any doctor’s is office is what insurance…</p>
<p>& some offices wont make an appt unless you give them your credit card number to charge the balance.</p>
<p>Magnetron. Your wife cleared 15k?</p>