I blog constantly about lifestyle choices and their relationship to preventable disease.
I talk about the rationing of health care based on lifestyle, not because I like to refuse care to those unable to provide for themselves (which I don't and wouldn't). But because, as a society, health care will be rationed to a far greater degree than it is today. Beyond any imagination you can think of in this country.
Pick your poison. Do you want rationing based on age, disease or lifestyle. You can't pick your age. Frequently you can't pick disease (unless it is lifestyle related). So I chose lifestyle due to a lack of other rationing techniques.
And I am mocked. A am verbally assaulted and insulted. I get slammed as heartless. As being an ass. As being a cold physician with no bedside manner, who doesn't care about the sick and dying patient in front of me who brought their illness upon themselves. And I am here to categorically state, in no other uncertain terms, that this opinion of me is just plain false. You have no idea how compassionate I am as a physician. I have an excellent bedside manner, excellent clinical skills. I also know my limitations and would go above and beyond the normal call of duty to practice good quality, communication driven care.
So I'm here to let you know, when I speak about rationing of health care resources, I am being brutally honest about what is coming. If you want America to pay for your health care get ready for the rationing of your access to life. The Medicare National Bank will not survive in its current FREE=MORE form. The greatest Ponzi scheme that ever lived. The biggest lie perpetrated on the American people since the denial of Roswell's existence.
I present to you British medicine, I beacon of care to which we are often ridiculed for not emulating. Even with time based rationing of resources in the Land of the Free (stuff) health care, it's still is not enough to sustain. I would like to thank a reader for finding my salvation and showing you that I am not alone in my quest to educate you on how screwed we really are.
I present to you the next phase of FREE=MORE known more aptly as socialized medicine:
They go on to add that "Public expectations are relentless". That's FREE=MORE folks, socialized style. This is exactly where America is heading. All health care delivery systems world wide that promise everything are unsustainable. Centralized planning will determine your fate. This is the unavoidable truth of government run health care.
One more reason that I will blog till the cows come home that you need to get out and exercise, stop eating at McDonald's and stop smoking if you want any chance to finish strong in your life. The government will not be there to save you as long as you believe they are your crutch to health care salvation.
With that said, I am ready to hear your apology. You cannot separate morality from economics in the current reality we all live in. You'd better get used to an economic driven performance based health care platform and ditch your morality, or find another way to pay for health care.
Perhaps we could give away smiley faces. Economics be damned.
Quit your whining. You write opinionated posts. People are going to disagree with you. Get over it. No one needs to apologize for anything unless they actually start to harass you.
ReplyDeleteHappy,
ReplyDeleteYou may be adorably cantankerous, but you are anything but heartless. A patient would be lucky to find a doctor with your smarts, dedication, and obvious compassion.
The question of rationing healthcare plagues me, a newly minted “expensive patient.” I am young, slender, non-drinking, non-smoking, healthy-eating, and active---always eager to run up flights of stairs rather than use an elevator. Now I’ve been diagnosed with a rare cancer and there is no end to the testing, consultations, surgeries, etc.
ReplyDeleteMy HMO and doctors seem eager to spend for anything that might help me; they never seem to consider the expense. It costs me nothing but a few co-pays, but it has surely added up to many hundreds of thousands of dollars by now for the insurer. I would never say that my allegedly positive “lifestyle choices” entitle me to unlimited healthcare, and I do worry that some other patient may get shortchanged down the line because my monstrous bills are being covered. No matter how much money goes into healthcare, it’s a finite amount, and whatever goes to me won’t go to someone else.
My cancer has a prognosis that, while not hopeless, is somewhere between lousy and disheartening, and how to treat it is uncertain at best. I want to live, but even so, I can’t help but think that it makes more sense to pay for low-level interventions that support the health of large numbers of people (vaccines, preventive care, etc.) than to shell out gabillions to help a few unlucky folks like me. No one is asking me to forego care because of the price tag, however, so I don’t. (If I did refuse care, they would probably send me to a psychiatrist, and I’d wind up costing my HMO even more.)
I dont see as you a heartless, I have met that kind of people, a big ego you might have but name a doctor who doesnt, very few, even nurses are arrogant (coughK, coughK).
ReplyDeleteThe are people that usually talk like they were heartless, but when you actually seen them interacting with other people they are really nice.
WORDS AND ACTIONS, I prefer someone like that, that someone that actually is an Ass, and you dont see that commming because they pretend to be nice, until you fail on their trap.
Happy is too concerned about the North American situation, when your health care fall on the same standards as ours, youll say "damn happy was right".
who else is more qualified than a doctor that works on public service to make critical suggestions?, in order to improve the outcomes on health care, in terms of economy and effiency.
Politicians? give me a break, they dont know anything about health, it took me years to actually understand what is going in my country in health care services. right now i can see the flaws I know politicians are incompentent, they dont know.
For example, I have made very acurrate recomendations to improve the efficiency of my hospital. was I at least heard? no... was a matter of money? no... is a matter of INOVATION, is a matter of analize what you need and what you dont need that much, is a matter of organization.
they want to show up a propaganda for society, tFREE=MORE as happy said
why do i have to test every child i see with WC because they have fever thats absurd, if you are told that 90% of them are viral, we can change that reality yes... of course we can.
politicians actually do a wonderfull thing, they give hope to people, they promise a better future. but future isnt build just by goverment management, future is forged by people, people that actually works efficiently.
one president or his/her cabinet cant change everything, but society can. but everyone is so selfish so greedy, There is people that give so little even if they are paid. people are too mediocre, thats what damages the world..
We have here a physician that actually love his job "a happy hospitalist", i guess if there were people like him around the world would be different. we need hardworkers, critical thinkers on all the fields of science to actually see a progress.
I was told since i was a medical student that preventive measures are far more efective than anything else. what would you aim prevention or rehabilitation. if you think that achiving that goal is imposible will be imposible.
People feel threathened by happy thought because of they freedom, people want freedom but they also want equality, there is not equality when someone smokes and others dont, there cant be equality when personal choice is involved, i dont have anything agaisnt personal choice, but its your choice is your fault.
name someone of lung cancer, i wont say MI, that hasnt regret of smoking.
If you dont value your life dont expect others will do in your place, as simple as that. i tell this as a physician that actually cares about their patients, but caring also involves, giving the patients part of the responsability of their health.
Happy, I feel your pain. I post about rationing, and the coming changes in healthcare not long ago, and was blasted for it. Whatever.
ReplyDeleteRationing is necessary. The UK is not the only country that does it, although it has probably been written about more in regards to their two tiered system, than anywhere else.
We need to have a very serious discussion regarding end of life issues, and prolonging care with expensive procedures, tests, and treatments, with little if any benefit.
Unfortunately, our culture is so wired to "american idol", that I don't believe that we are capable of such difficult decision making anymore. Speaking of being mocked....I was teaching an intern the other day who told me that my personality was VERY similar to Dr Cox from the TV show "Scrubs".....I'm not quite sure how to take that. (confused)
Sorry Happy - have to diasgree. We should ration based on reasonable expectation of meaningful recovery.
ReplyDeleteI don't see the point of coding, dialyzing and traching a pt who is in a persistant vegitative state because he got hit by truck jogging. On the other hand, a cath for a hypertensive diabetic might make a lot of sense if he's functional.
No one wants to get leukemia, or amyloidosis or scleroderma or any other horrible disease but we have to be realistic about what will happen to them. Mechanical ventilation, ACLS protocols and dialysis do not change slow these disease processes. Once people have no hope of recovery, their care needs to be focused on helping their quality of life, not their length of life. Even if they had an exemplary lifestyle.
Sometime it stinks, but we can't help everyone live forever. Maybe we need to embrace the concept of "real age" or "realistic time remaining."
I had an attending who started every note "this is a patient who is dying of ..." Helped keep things in perspective.
Happy,
ReplyDeleteI'm sure you realize that a large portion of your readership, myself included, is by other physicians who find catharsis in your posts. As hospitalists, we've all had those days where you realize that the last 8 rooms you walked in were patients who flatly did it to themselves. Because it affects discharge planning, we know who is "self-pay" (charity care), Medicare, Medicaid, private insurance (rare).
I, for one, am glad that you're trying to spread the news that a lack of personal responsibility is going to HAVE to translate into a reduction of access to healthcare as long as people expect their care to be paid for.
Unfortunately, I fear that we are probably outnumbered by Americans who think that healthcare is not only a right, but a service they should have access to even if 100% of their health problems arose from the way they chose to abuse their bodies/lives.
The reality is painful. We can't afford the path we're on. The solution is going to piss off a lot of people. Unfortunately, I fear that the few politicians who understand what needs to be done know that such actions are political suicide.
YOU try to go tell the entitled American masses that the feeding frenzy of healthcare spending will be cut off from them if they don't put down the fork, get off their asses, and stop smoking.
There are millions of Americans who are doing what they can to live a healthy life, and sh*t happens. That is what health insurance is supposed to cover. Those are the patient interactions I tend to enjoy the most.
Like you, I have confidence in my skills and my bedside manner while knowing the limits of my training. I think I'm a pretty darn good doc myself.
But I can still be a great physician, have a great bedside manner, provide excellent care to a patient, and still reject the notion that my tax dollars should subsidize recurrent hospitalizations for my sweet-as-apple-pie grandma with COPD and ongoing tobacco abuse.
Rationing is here - read this post and the comments. Anonymous 3:16 made some good points about quality of life vs length of life.
ReplyDeleteMaybe statutory advance directives should mandatory for all, at minimum upon becoming Medicare-eligible.
In my area, one can choose to receive the most heroic and costly treatments, regardless of potential outcome and payment therefor.
I'm apologize - I don't want to take food out of the mouths of ICU nurses, but I haven't much sympathy for Terri Schiavo-like "corpses on ventilators". Perhaps the choice should be amended to receiving only the heroic measures and treatments that will be paid for.
And maybe gutless nursing home administrators that send near-death patients to the ED to get rid of "their problem" using EMTALA as an excuse, rather than sending such patients to hospice or palliative care should have to bear partial responsibility for payment.