How does society prevent one from taking it freely.

http://www.nytimes.com/2007/07/10/health/policy/10health.html?ex=1341720000&en=d3aed41589367049&ei=5088&partner=rssnyt&emc=rss

How do you increase the number of payers(which is the biggest problem), and amount paid into a system?

At the same time increasing the number of those getting the services?

Without those who don't pay into the system abusing it?

How do you contain the costs if people come in and cost the system, thousands of dollars for colds and fevers? (and of course expecting that everything gets fixed, no matter the cost).

First thing that needs doing is to define this service and it's price as part of the "base cost" of running a society, along with military and road building and all that.

Then realise that because something is cost-free for the individual user, does not mean that the supplier has to give the user what he wants when he wants. The fact that you have to actually be ADMITTED to a hospital need not change, for instance.

And what abuse are you on about?

How'd we do it with the Freeway system?

I don't understand.

Why would building roads be at all like providing healthcare? Once the road was built, it does not really cost anything anymore until it needs to be repaired. If I drive on the road yesterday it does not cost society money, or today there is no additional cost to society, same with tomorrow.

Freeways, not to be confused with toll highways or turnpikes, were usually built with bonds, then the loan is paid back. Upkeep is maintained through use taxes, mostly, or additional bonds(loans).

Healthcare is not at all like freeways. It is a service, one provided by very expensive workers. There is an expensive cost associated with every single use of the service.

Currently the problem is two fold.
Not enough payers into the system.
And a change in mentality of people, who now go to the hospital for minor problems. Things that in the past, you just fixed yourself at home, or went to a private doctor's office for.

Go to the emergency room waiting room of any hospital. All of people waiting in there, do NOT have an emergency. Many of them need to see a doctor or practitioner. Many of them should have stayed home, and fixed it themselves.

If healthcare becomes free, human nature being what it is, how do you prevent even more people from accessing healthcare services.

Tinsi suggests restricting access through appointments. Which really does not fix the problem, only shifts it to long waits when you really need stuff done. A lowering in quality for those who currently pay into the system and get speedy service from it, ie those people especially should not get crappier service.

Is that really acceptable, decrease in quality for those who currently pay into the system and those who keep it running now, so that poor people can access healthcare?

If that is the solution, then a tiered system of service makes better sense. And just put more money into the low tiers. That is still not universal healthcare, of course, but it would provide better service for the poor, than they have now.

Tinsi, admission to a hospital only means that you are going to stay longer than 24 hours. Huge expenses can be incurred in 23 hours, and do. It is one of the largest cost centers of any hospital. We have a law in the US called EMTALA, which means that every hospital with an emergency room must treat you without pay. Rarely are those people who access ER care admitted to the hospital. They are treated in the ER, then sent home.

That is simplified of course, what really happens, is that the hospital will still charge you for your ER visit. Because there is disproportion between those who use the service, and those who pay,,,the charges for every service and every item used is proportionately increased to make up the difference. If 10 people visit, they send out 10 bills, 9 don't pay, 1 does. The charges are thus proportional to that. That is to say, that the hospital charges each of those 10 people time times what it cost really them, and when that 1 person pays, he pays for the other 9 people's healthcare.

That is the most major reason why there has been such an increase in the costs of healthcare, not enough payers. And if universal healthcare were enacted, both of those problems would increase, knowing human nature. 20 people, instead of 10 will access the system, and now 19 people, instead of 9, are not paying for that service. How do you prevent that?

That is the most major reason why there has been such an increase in the costs of healthcare, not enough payers. And if universal healthcare were enacted, both of those problems would increase, knowing human nature. 20 people, instead of 10 will access the system, and now 19 people, instead of 9, are not paying for that service. How do you prevent that?
Well, if health care were universal then everyone would have to participate in paying for it, if they had any income at all. Or every employer or some combination of the two. Right now there are a lot of people that don't get health insurance because they don't want to pay anything for it and assume they'll stay healthy, or perhaps they can't get health insurance due to a pre-existing condition. The idea behind Massachusetts's plan is that EVERYONE, even the very young and healthy, will become part of the pool.

As near as I can see it, we already pay for some level of health care for the very, very poor and the people here illegally, because they end up in the hospital.

As far as controlling costs well, I think that's a huge issue that requires changes at fundamental levels in our society. People can't assume that they can eat like crap, drink like fish, smoke like chimneys and that the health care system will patch them up when they have diabetes and lung cancer and fatty livers. People need to learn that there is a connection between the crap they eat and the diseases they're getting (or will get) and that the trade off between convenience food and health is not a good one to make. But that requires a lot of education and breaking free of the food industrial complex (General Mills, Kraft, etc) and they're all buying our politicians influence... so we need serious campaign reform. So this is a hugely complex issue that strikes at the heart of this very consumer oriented society we've built where more time is spent choosing your socks than in preparing meals any longer.

I don't understand.

Why would building roads be at all like providing healthcare? Once the road was built, it does not really cost anything anymore until it needs to be repaired. If I drive on the road yesterday it does not cost society money, or today there is no additional cost to society, same with tomorrow.

I didn't mean to compare them qualitatively, but in the sense that you'd have to change mentality about it, and start thinking about the cost of health care as part of the base cost of running the society.

If healthcare becomes free, human nature being what it is, how do you prevent even more people from accessing healthcare services.

uhm, you don't. The whole POINT is to make health care accessible to everyone.

Tinsi suggests restricting access through appointments. Which really does not fix the problem, only shifts it to long waits when you really need stuff done.

Oh, you're thinking that going to the doctor as well should be free? No, no. You pay for the doctor's time. Also in the ER, unless your visit there gets you admitted to the hospital. Not a huge lot, but enough to make you not bother about waiting 3 hours in the ER for a cough. Treatment, hospitalization and/or medication is free. So if you go see a doctor for no reason, you get to pay for.. well.. nothing.

Tinsi, admission to a hospital only means that you are going to stay longer than 24 hours.

There's no universal, unchangable law that says that. It's just current practice. If that's how you practice it, and if it's a problem - change it.

uhm, you don't. The whole POINT is to make health care accessible to everyone.
That is not my point(might be yours). My point is to have healthcare accessible for everyone, and have everyone pay for it. And how do you do this without decreasing present quality for the existing payers.

I mean, it is present payers who keep the system today running. It would be morally and ethically wrong to have them, the ones who are actually productive and paying, take a hit in quality. That is just bad faith. They are already paying for the healthcare of those who don't pay into the system, if we add more non payers, it would unfair to make them take the hit.



Oh, you're thinking that going to the doctor as well should be free? No, no. You pay for the doctor's time.
People presently go to the ER to see a doctor. And don't pay him or her for his or her time.

Also in the ER, unless your visit there gets you admitted to the hospital.
ost people are treated in the ER, by doctors and nurses, then sent home than who come to the ER and stay at the hospital. And most of those people are not payers now. And under universal healthcare, there will be more of them.

How do you prevent that?


Not a huge lot, but enough to make you not bother about waiting 3 hours in the ER for a cough.
Or a stomach ache? Like that abusing-the-system-drug-seeker down in LA died waiting to see a doctor, with a perfed bowel.

Treatment, hospitalization and/or medication is free. So if you go see a doctor for no reason, you get to pay for.. well.. nothing.
No they are not, they are expensive services and products. And the more non payers access the system, now or later(after universal care), the more payers have to pay.

You have to give me that payers are already accessing the system to the extent they will access the system after universal healthcare. There is no incentive right now for payers into the system not access the system. There would be no, or little, incentive for them after to access it more.



There's no universal, unchangable law that says that. It's just current practice. If that's how you practice it, and if it's a problem - change it.
EMTALA is one of the most unethical laws ever enacted, and it has been on the books for over 20 years. This one law is responsible for the closure of thousands of ERs, hospitals, and the exponential rise of the cost of healthcare for everyone.

You've got blinders on to the fact there could be a lot more PAYERS into the system if employers, employees and EVERYONE had to pay, that it wasn't optional.

Most people are treated in the ER, by doctors and nurses, then sent home than who come to the ER and stay at the hospital. And most of those people are not payers now. And under universal healthcare, there will be more of them.

How do you prevent that?

I think I already answered that.

I think I already answered that.

Well, I find that waiting for an appointment to see a practitioner for a condition I have now, unacceptable.

It is not really an answer.

If you have a flare up of HPV or HSV, do you find it acceptable to wait a week or a month or half a year to see your doctor or practitioner. I know most women find waiting that long(six months) to get a PAP smear, or exam, accept that level of service. That is to say, they are use to it.

I don't. (men usually wait until it is really broke before seeing a doc, anyway).

If universal healthcare means longer waits to see a healthcare provider, that really is not a fix of a broken system, it is just breaking something else.

You've got blinders on to the fact there could be a lot more PAYERS into the system if employers, employees and EVERYONE had to pay, that it wasn't optional.

How do you get poor people to pay into the system?

And pay their fair share?

They also aren't paying into the system now and yet make use of hospitals and free services. But there's lots of employers that don't have health insurance benefits for their employees. So if it is paid for by employers and people then there's a lot more people paying into it. And if you don't have share holders and CEO's with massively bloated salaries to pay, then a lot more of that money would be going to paying for services. How much paperwork do hospitals and doctors do that is just for insurance purposes? All that labor... gone. And then, how many surgeons get paid per surgery and hospitals make money off of surgery and getting rid of that incentive to cut people open and make money off of what're probably lots of times unnecessary operations... gone. Pay them a salary and there's no incentive to performing unnecessary surgeries. Heart disease is HUGE money for hospitals: Get the picture? We've had a battle with heart disease and the hospitals have won. The enormous success of hospitals over the last 20 years is not because of delivering babies, it's not from psychiatric hospitalization, it's not from cancer treatment. It's from heart disease. The largest floors in the hospital are usually the cardiac floors. The bulk of revenues and profit are from heart disease.
http://heartscanblog.blogspot.com/2006/11/red-badge-of-courage.html

A lot of making health care a free enterprise zone is part of the reason why it is getting so bad. When someone can make $70,000 bucks performing an operation then everyone suddenly looks like a good candidate for an operation.

Somehow pretty nearly all western countries are managing to do this, we can't be that stupid that we can't figure it out too. Or are we?

They also aren't paying into the system now and yet make use of hospitals and free services.
Yes, in the present system it is a large enough percentage to tax and break the existing system.

When it is universal, you don't see or predict that all the people who think to themselves, "I can't go to the hospital, because I can't afford it", will go and use it, costing even more. That is a HUGE number. I know these people. You don't think they will access the system when they know they don't have to pay?


But there's lots of employers that don't have health insurance benefits for their employees.
It makes no sense in a rational sense why employers have to pay for healthcare. As a benefit, a way to attract qualified workers, it makes sense. But to mandate that they do, to pay for people who don't work for them, for people they don't know, is a silly irrational notion.

It makes better sense to mandate colleges and universities pay for healthcare, rich people go to college, they can afford it. And especially churches, they don't really do anything, produce no product, and people just give them their left over money(tithes).

So if it is paid for by employers and people then there's a lot more people paying into it.
Ya, but are they the right people to be paying for unemployed peoples' doctors visits. They are producing a service or product, already for the benefit of society. Providing jobs, and tax revenue for most things already.

And if you don't have share holders and CEO's with massively bloated salaries to pay, then a lot more of that money would be going to paying for services.
Well if the owners of companies need to pay their CEOs more money to attract better workers, can you blame them.

How much paperwork do hospitals and doctors do that is just for insurance purposes?
A lot. But more paperwork is done to protect against future lawsuits than any other reason. Same with tests and procedures.

All that labor... gone.
Well, in all fairness, docs don't really do a whole lot of actual paperwork themselves at doc hourly rates. They have others do it for them.

And then, how many surgeons get paid per surgery and hospitals make money off of surgery and getting rid of that incentive to cut people open and make money off of what're probably lots of times unnecessary operations... gone.
ost unnecessary procedures are done to prevent future lawsuits, or present ones, or even pay for the past ones.

Pay them a salary and there's no incentive to performing unnecessary surgeries. Heart disease is HUGE money for hospitals:
http://heartscanblog.blogspot.com/2006/11/red-badge-of-courage.html

Angiocaths have seriously cut into open heart surgery numbers. If people want to show off their femoral scars, good deal.


A lot of making health care a free enterprise zone is part of the reason why it is getting so bad. When someone can make $70,000 bucks performing an operation then everyone suddenly looks like a good candidate for an operation.
Docs don't make the 70K for the operation. The hospital does. Much of that cost is that high to cover other operational costs, such as unpaid ER patients. If you did a materials and labor analysis of a typical heart operation, it is a fraction of that. They have to pay me when I take care of that unemployed illegal alien who needs to be detoxed up in ICU, somehow. He's never going to pay for his care, they 60 year old guy who was paying into the system his whole life is going to pay me. You need to pay me, the house keepers, the CNAs, the people who make the food for all the patients, you need to pay the security guard who sits in the ER waiting room all day, the operator who answers the phone, the ward clerks who work their asses off for **** wages. The IT people who just put in a crappy computerized charting system, and you need to pay to send people to their seminar down in LA, to see how you can make it better. All of that and more comes out of that 70K.

Actually that 70K is pretty low, if you have a hip replacement, that one is going to cost you 60K. If they crack your ribs and cut your heart, you are looking at much more. You got at least 3 docs in the room at that time, one to work on the heart, one anesthesiologist, and one to harvest your saphenous veins.

Somehow pretty nearly all western countries are managing to do this, we can't be that stupid that we can't figure it out too. Or are we?
I don't like any of the other countries systems. Besides Norway's, of course. I think that is the best system so far. If I am paying a 10th of my total production into healthcare, I want to be seen today, or at worst, tomorrow. And I don't want my leg amputated because I broke it.

Oil underneath(or any natural resource) a country should belong to everyone in that country. And it should subsidize something like universal healthcare, or free basic nutritional needs.

But how do we get there from here? I don't think we can(nationalize all of our oil). Oil companies take, more than any other type of corporation or company or business. Even Satan controlled Wal*Mart is a monastery of charity and community service, in comparison.

Well, someone should crunch the numbers. It isn't an impossible task to do. I still say that somehow a lot of countries are providing health care for all their residents and yes, it costs a lot, but they've decided that everyone deserves some kind of health care. I guess sort of like we decided many, many years ago that no one should starve to death in the USA.

Right now they go to the hospital for doctors visits if they can't pay, because the hospitals aren't supposed to turn them away. If everyone had health care, I think emergency rooms would once again be used for emergencies. Although... people probably need some education as to what an emergency is.

If employers pay, their employees are actually paying, by getting less wages. So it doesn't matter. Some people are going to get free health care without paying into it enough, some people are going to not pay. I think when you've decided that to take care of your citizens you just have to come to terms with that.

Well, someone should crunch the numbers. It isn't an impossible task to do.
Well, they are hypothetical numbers. Of course. It would be hard to exactly determine how many people would come out of the woodwork and demand services that they don't already demand. But knowing human nature, if you have been getting cheap ass food for free, and now you get to go dine at a 5 star restaurant for free,,,you can sure as bet your house, more people are going to line up for it.

I still say that somehow a lot of countries are providing health care for all their residents and yes, it costs a lot, but they've decided that everyone deserves some kind of health care.
I don't care about other countries. I said that. We are the United States of America. We can come up with our own solution.

I guess sort of like we decided many, many years ago that no one should starve to death in the USA.
Well ya, but but. I can feed a person for the rest of their life on 20K. That does not even cover a single gall bladder removal, today.

Right now they go to the hospital for doctors visits if they can't pay, because the hospitals aren't supposed to turn them away.
That is EMTALA. Remember that there was no mandate by the law to pay for any of the costs of the services that must be provided.

If everyone had health care, I think emergency rooms would once again be used for emergencies.
Why would you think that?

Although... people probably need some education as to what an emergency is.
I think you are getting closer to the solution to this problem, we'll see.

If employers pay, their employees are actually paying, by getting less wages.
No, the employers are paying employees to work. They offer benefits to attract better employees. I personally have decide to take the differential, 18%, rather than the benefit. Because I am healthy, and makes better financial sense to me at this time.

So it doesn't matter.
oney matters. Because it is a quantification of time, of labor. If labor and time is taken against will, that is slavery.

Some people are going to get free health care without paying into it enough, some people are going to not pay.
How do you fix that? Use your imagination, there are plenty of ways to make deadbeats pay for what they get.

I think when you've decided that to take care of your citizens you just have to come to terms with that.
Not by glossing over the details. I don't give a rats ass about 'taking care of citizen'. Any freaking 3rd generation welfare trailer park trash illegal alien spawn is a citizen.

What I do want is for people to get healthcare when they really need it. And I want them to pay their fair share.

Those are two different things.

How do you increase the number of payers(which is the biggest problem), and amount paid into a system?By imposing taxes in other areas and feeding them into the system. It's not as though it were some closed loop.

That includes a tax on both employers and hospitals, as well as other taxes that tie in to health care (fat tax, tobacco tax, alcohol tax, and so on).

Hell, legalize marijuana and tax that too. Instead of spending untold billions policing a relatively harmless plant, we can make a fortune and dump it back into the system.At the same time increasing the number of those getting the services?You're not increasing the number. You're just shifting around the way they get the services to make it more efficient.

Like, all those people who go to the ER for non-emergencies. They are there because that is the only way they can get free treatment. So today, instead of giving them a free office visit costing $100, we give them a free ER visit costing $1,000-$10,000.How do you contain the costs if people come in and cost the system, thousands of dollars for colds and fevers? (and of course expecting that everything gets fixed, no matter the cost).First, you fix the current screwed up system that requires them to go to the ER for such things in the first place. If we allow people to schedule office visits, and set up walk-in clinics for minor conditions (e.g., UCSF's clinic), people will use them. Because that's what they really want, to get quick and effective treatment, not to sit 5 hours in some filthy ER with sick people everywhere.

Second, there are many ways to contain costs that will not compromise health care. For example, tort reform. Look at Texas's example (http://news.yahoo.com/s/ap/20070709/ap_on_he_me/doctor_backlog), they enacted a noneconomic damage cap in 2003, and malpractice premiums have plunged over 20%. There are so many new doctors wanting to practice in Texas, the medical board is getting overwhelmed with the applications.

And of course, doctors and nurses will have to take a large cut in pay. In Canada and the U.K. their salaries are much lower and more sensible.

If your butt just touches a bed in our ER, you get billed $999.00. Just for touching it.

You don't even have to get up on it, if it just touches a bed.

I **** you not.

If you stand during your ER stay, you save that thousand dollars.

If your butt just touches a bed in our ER, you get billed $999.00. Just for touching it.

You don't even have to get up on it, if it just touches a bed.

I **** you not.

If you stand during your ER stay, you save that thousand dollars.All the more reason to reform the system so that non-emergent cases don't go to the ER to begin with.

It is extremely easy to do; if people are given the option to make free office visits, or visit a walk-in clinic offering fast treatment, they will do it. Not just because it costs us taxpayers less, but because it's better for the patient.

The only people who will lose out on this deal are those making money off the current system, e.g., you.

By imposing taxes in other areas and feeding them into the system. It's not as though it were some closed loop.
Exactly. Tax areas related to healthcare costs. I agree. Businesses have NO connection to healthcare costs. Hell, they have been subsidizing it for years, years after the reason why they started(for their own benefit).

That includes a tax on both employers and hospitals, as well as other taxes that tie in to health care (fat tax, tobacco tax, alcohol tax, and so on).
Why tax hospitals? My hospital is already a non profit. And provides millions each year in free healthcare to indigents and non payers.

Hell, legalize marijuana and tax that too.
I will make a Libertarian out of you, yet.

Instead of spending untold billions policing a relatively harmless plant, we can make a fortune and dump it back into the system.
Don't forget caffeine and chocolate. If you are going to tax a plant, what better plant than one that make frillions of dollars for coffee and chocolate dealers.

You're not increasing the number. You're just shifting around the way they get the services to make it more efficient.
Of course you are going to increase the number of users. And the number of visits. If it were free to go to Six Flags and Disneyland, who would not go, or not go more than they do now?

Like, all those people who go to the ER for non-emergencies. They are there because that is the only way they can get free treatment.
And many don't go because they erroneously think they have to pay. When you tell them that they don't, many many more will go.

So today, instead of giving them a free office visit costing $100, we give them a free ER visit costing $1,000-$10,000.
Yes. But remember that the actual labor and materials cost of that visit does not REALLY cost that much. It is inflated, because it is a cost center which does not have enough payers.

First, you fix the current screwed up system that requires them to go to the ER for such things in the first place.
Well, ya. You should not be in an ER unless an ambulance brought you. ERs are for emergencies.

They are not used for that, now, of course.

If we allow people to schedule office visits, and set up walk-in clinics for minor conditions (e.g., UCSF's clinic), people will use them.
Well, UCSF is a teaching hospital. There are tons of docs and nurses to be, just chomping at the bit to get clinical experience there, and without getting paid. That is a poor model for care elsewhere(unpaid doc students and unpaid nurse students).

Because that's what they really want, to get quick and effective treatment, not to sit 5 hours in some filthy ER with sick people everywhere.
No, I want people broke(who are broke even) fixed. I don't want broke ass people milking the system.

Second, there are many ways to contain costs that will not compromise health care. For example, tort reform. Look at Texas's example (http://news.yahoo.com/s/ap/20070709/ap_on_he_me/doctor_backlog), they enacted a noneconomic damage cap in 2003, and malpractice premiums have plunged over 20%. There are so many new doctors wanting to practice in Texas, the medical board is getting overwhelmed with the applications.
Of course tort reform is going to be part of this. I will love the day when some OB doc hands a piece of paper stating, "I have no insurance to cover you if your baby dies in childbirth, you assume all risks involved in the delivery of your baby", and I have no assets from which you could collect from. "Sign here___".

And of course, doctors and nurses will have to take a large cut in pay. In Canada and the U.K. their salaries are much lower and more sensible.

I will not serve you for a penny less than what I make now, for what I know and what I do. I will find another job first. I would go back to Wal*Mart moving boxes at night first.

All the more reason to reform the system so that non-emergent cases don't go to the ER to begin with.
ost ER cases are not emergencies. I assure you of that.

It is extremely easy to do; if people are given the option to make free office visits, or visit a walk-in clinic offering fast treatment, they will do it.
That's what we need.

Not just because it costs us taxpayers less, but because it's better for the patient.
Taxpayers is not the only issue. Not now. Like you said in the other thread about taxes, they don't only have to be from government. They can also be from private sources.

I am trying to keep this topic open to the thought of a universal HSA type model. Where people pay into their own account, and control that account until it is needed. Not just for the deductible, but for any amount of expense they might have to incur.

The only people who will lose out on this deal are those making money off the current system, e.g., you.
I assure you that the service that I am providing is(at least) at the level of my recompense. I have made more, knowing far less, and doing far less, in my past careers.

Are there nurses who don't. Yes. Are there overpaid nurses, yes. My hospital is non union, but actively does surveys of what other nurses are making at other hospitals. We don't make as much as the higher paying places, and we all know it; it is acknowledged and admitted. But we work there despite the lower differential, because of the work environment and atmosphere.

Nursing students don't regularly get hired into ICU right out of nursing school. Those who do are usually exceptional. But I make just the same as any floor nurse does, even those fresh off the boat from China who don't know what BNP or CPK stand for.

If you have a flare up of HPV or HSV, do you find it acceptable to wait a week or a month or half a year to see your doctor or practitioner. I know most women find waiting that long(six months) to get a PAP smear, or exam, accept that level of service. That is to say, they are use to it.

Educate more doctors then, if there's such a shortage of them that people have to wait that long.

Why tax hospitals? My hospital is already a non profit."Non-profit" is just an accounting formality. You all make money, each and every one of you, from the janitor to the chief of staff. And you milk your customers (including their financial backers, insurance companies and the U.S. and state government) to get that money.Of course you are going to increase the number of users. And the number of visits. If it were free to go to Six Flags and Disneyland, who would not go, or not go more than they do now?What are you talking about? It is free NOW. Anyone can go to the ER and must be treated even if they can't pay. In fact, indigents must go there because they're not allowed to go for a simple office visit. That model is retarded, and is what needs to be fixed.Exactly. Tax areas related to healthcare costs. I agree. Businesses have NO connection to healthcare costs.Business also have no connection to the war in Iraq, but they help pay for it. We don't need to adopt a one-dimensional libertarian model where you pay only for the precise service you use, no more and no less. It doesn't work.I am trying to keep this topic open to the thought of a universal HSA type model. Where people pay into their own account, and control that account until it is needed. Not just for the deductible, but for any amount of expense they might have to incur.And what if they can't afford the procedure? The idea behind universal health care is that it's, well, universal.

When it is universal, you don't see or predict that all the people who think to themselves, "I can't go to the hospital, because I can't afford it", will go and use it, costing even more. That is a HUGE number. I know these people. You don't think they will access the system when they know they don't have to pay?

And again - making health service accessible also to these people is the POINT. One should encourage it, not discourage it. Trying to get sick people to stay out of the health care system should not be the way to fix fiscal problems in a system which is supposed to be availiable to all.

No, the employers are paying employees to work. They offer benefits to attract better employees. I personally have decide to take the differential, 18%, rather than the benefit. Because I am healthy, and makes better financial sense to me at this time.
Well there! That's my proof. If we had universal medical coverage you'd be paying into the system. More people covered, yes, but more people also paying in.

"Non-profit" is just an accounting formality. You all make money, each and every one of you, from the janitor to the chief of staff.
Well of course we make money for the work we do. If we did not, that would be called slavery. There are no shareholders which make money.

The US outlawed slavery over a hundred and fifty years ago or so.

The owning of slaves is frowned upon in our society.

Well of course we make money for the work we do. If we did not, that would be called slavery.

Or internship *snicker*

Non-profit status of hospitals is pretty much a scam. There's still executives getting outrageous salaries.
Non-profit hospitals

Take a look at your local hospital and you're likely to notice several curious things:

1) It is likely non-profit, meaning it enjoys a non-profit status with the Internal Revenue Service and enjoys the tax benefits of not paying taxes on profits. This provides an advantage to tax-protected hospitals. 70% or more of hospitals in the U.S. are "non-profit."

2) Non-profit or no, many hospitals operate under the guise of a religious affiliation, e.g., St. Mary's Hospital, Trinity Hospital, All Saints', Jewish Hospital, etc.

3) Executives in non-profit hospitals can make capitalistic salaries. One CEO of a Milwaukee hospital took home $3.7 million dollars in salary last year. That's not including the very substantial perks and business interests in the spin-off businesses the hospital owns, including pharmacies, drug and medical device disitributors, even a venture capital division. "Non-profit" does not have to mean that executives within the operation can't benefit handsomely.

That same hospital system spends over $10 million dollars in a year in local marketing for TV ads, print advertising, etc. Ads are slick and professionally produced.

ake no bones about it: These are "non-profit" for tax purposes only . They are for-profit in every other sense of the phrase, including rich rewards for the insiders.

Guess how those fat executive salaries and large marketing budgets are paid for? That's right: the 12-inch incision in your chest; the four stents, defibrillator, and repeated nuclear stress tests; the revolving door of hospitalization after hospitalization that typifies the "heart patient" experience.

See the hospital for what it is: In the 21st century, it is no longer a charitable operation worthy of your volunteer time and donations. It is a business no different than Home Depot, IBM, or--Enron. Yes, they do perform needed services, as well. But the perverse equation that often determines who needs hospitalization and who doesn't, who needs a heart procedure and who doesn't, is not always based on necessity but on financial return. Just ask the CEO.

http://heartscanblog.blogspot.com/search?q=non-profit

Non-profit status of hospitals is pretty much a scam.

Explain?

Explain?Read the quote above. The term "non-profit" is intended to apply to organizations primarily concerned with public welfare, not making a profit. But hospitals are all about making as much money as possible, which is then drained to the employees. And if the organization itself has income, it doesn't have to pay taxes, which is the same as taking money involuntarily from the hands of the taxpayers (slavery in your language).

Non profit designation is for organizations which do not divide/share profits to shareholders(owners).

asons. And essentially all fraternal organizations are non profit.
DAR. Red Hat Society, and other social groups.
Fraternities.
Sororities.
Clubs.
Schools.
Universities.

The employees have to pay the taxes on their earnings, it is not like the money's going untaxed. Which is no different than for profit companies, except those organizations have to pay corporate tax on the 10 percent profit or so above expenses. The net, not income as you say.

What would otherwise be the profit for the hospital(which would otherwise go to shareholders) goes into hiring more employees and buying more beds.

It does not have to pay tax, because the hospital has no profit(no net) to tax, anyways. It is not being taken out, so how could it be. But all the employees are taxed, I assure you. The net is spent.

Business and corporations do not pay tax on income. They pay tax on the net. If there is none, then they don't pay tax, either.

I still don't understand your point, unless you are under the impression that hospitals are suppose to be charities and have workers who work for free. And I have NO idea where you got that, if you have it. The guy in that blog piece seems to have that notion. I would have hoped that you all here are smarter than he.

Other types of non profit organizations.

§ 501(c)(1) - Corporations Organized Under Act of Congress (including Federal Credit Unions)
§ 501(c)(2) - Title Holding Corporation For Exempt Organization.
§ 501(c)(3) - Charitable Organizations - Charitable, religious, educational, scientific, literary, etc. organizations.
§ 501(c)(4) - Civic leagues, community organizations, and other social welfare organizations.
§ 501(c)(5) - Labor unions, farm bureaus, and other labor and agricultural organizations.
§ 501(c)(6) - Trade associations, chambers of commerce, real estate boards, and other business leagues.
§ 501(c)(7) - Hobby clubs, country clubs, and other organizations formed for social and recreational purposes.
§ 501(c)(8) or § 501(c)(10) - Lodges and similar orders and associations.
§ 501(c)(19) and § 501(c)(23) - Posts or organizations of past or present members of the Armed Forces of the United States.
§ 501(c)(4) - Local associations of employees.
§ 501(c)(9) - Voluntary employees' beneficiary associations.
§ 501(c)(17) - Supplemental unemployment benefit trusts.
§ 501(c)(11) - Teachers' Retirement Fund Associations.
§ 501(c)(12) - Benevolent Life Insurance Associations, Mutual Ditch or Irrigation Companies, Mutual or Cooperative Telephone Companies, Etc.
§ 501(c)(13) - Cemetery Companies.
§ 501(c)(14) - State Chartered Credit Unions, Mutual Reserve Funds.
§ 501(c)(15) - Mutual Insurance Companies or Associations.
§ 501(c)(16) - Cooperative Organizations to Finance Crop Operations.
§ 501(c)(18) - Employee Funded Pension Trust (created before June 25, 1959).
§ 501(c)(21) - Black Lung Benefit Trusts.
§ 501(c)(22) - Withdrawal Liability Payment Fund.
§ 501(c)(25) - Title Holding Corporations or Trusts with Multiple Parents.
§ 501(c)(26) - State-Sponsored High-Risk Health Coverage Organizations.
§ 501(c)(27) - State-Sponsored Worker's Compensation Reinsurance Organizations.
§ 501(d) - Religious and Apostolic Associations.
§ 501(e) - Cooperative Hospital Service Organizations.
§ 501(f) - Cooperative Service Organization of Operating Educational Organizations.
§ 501(k) - Child Care Organization.
§ 521(a) - Farmers' Cooperative Associations
§ 527 - Political parties, campaign committees for candidates for federal, state, or local office, and political action committees.

Explain?
Read the article I linked.

The only redeeming virtue of non-profit hospitals, so far as I can see, is that they don't have share holders to pay. But the fact that their CEO's and probably board members are pulling down obscene salaries and have these spin-off businesses tells me it is a sham. You shouldn't be able to have a non-profit if you're profiting hugely from it.

I still don't understand your point,I still don't understand yours, when you say:Why tax hospitals? My hospital is already a non profit. And provides millions each year in free healthcare to indigents and non payers.You seem to be implying that hospitals are somehow more charitable than, or different from, other businesses. They're not, in any practical sense at least.

Also, just because your hospital breaks even on a technical accounting level doesn't mean it can't or shouldn't be taxed. Think of it as a tax on your employees, and suppliers, if it makes you feel better.

Why tax hospitals? My hospital is already a non profit. And provides millions each year in free healthcare to indigents and non payers.
It isn't really free. It's being paid for by the rest of us who would have our homes foreclosed on, or wages garnished if we didn't pay our hospital bills.

For profit hospitals can, and do, make the same claim to providing "free" health care to indigents.

The only redeeming virtue of non-profit hospitals, so far as I can see, is that they don't have share holders to pay. But the fact that their CEO's and probably board members are pulling down obscene salaries and have these spin-off businesses tells me it is a sham. You shouldn't be able to have a non-profit if you're profiting hugely from it.

But there is no net. No profit in the first place.

It is all spent.

What are you like, the idiots on late night informercials, where you don't know the difference between gross and net? "I made 20,000 dollar profit on my first real estate deal..."

It isn't really free. It's being paid for by the rest of us who would have our homes foreclosed on, or wages garnished if we didn't pay our hospital bills.

For profit hospitals can, and do, make the same claim to providing "free" health care to indigents.

You can say that about any charity, then.

That it is the donators, or the customers(say in regards to the Bill and Melinda Gates Foundation), that are really making the donation.

That if I donate anything to anything, that it REALLY whoever I soaked to earn the money in the first place, who is REALLY providing the gift.

I still don't understand yours, when you say:You seem to be implying that hospitals are somehow more charitable than, or different from, other businesses. They're not, in any practical sense at least.
No, I am not. Stating what is.

Also, just because your hospital breaks even on a technical accounting level doesn't mean it can't or shouldn't be taxed.
How can you tax justify taxing expenses of running a business? And not profit.

It sounds like you absolutely have no idea what you are talking about, no idea of basic economics or business.

Think of it as a tax on your employees, and suppliers, if it makes you feel better.
Employees are taxed. Why would you say they are not? Believe me, I am taxed a LOT.


You two sound like you are arguing, just to argue, you guys make no sense at all. No basic comprehension on how a business operates. Have you ever run a business, profitable or otherwise? At all? I mean a real one, say one you had to pay for an ad in the Yellow Pages or newspaper.


I don't know many businesses who would serve the customer I served all night last night, for free. I don't know of any which would frankly. Oh, and make not stupid inference that I worked for free. I did not work for free, I charged the hospital a LOT of money to work for them, and her, all night long. Same with the doc, he charged the hospital a LOT to keep this homeless woman alive.

You know, this line is of debate is like trying to teach a bonobo Javascript. Now that I think of it, a complete waste of my time.

How can you tax justify taxing expenses of running a business? And not profit.

It sounds like you absolutely have no idea what you are talking about, no idea of basic economics or business.No Fyyr, it's you who has no idea what he's talking about. Business are taxed all the time on expenses and factors not tied to their profit.

For example, my employees are an expense, yet I still have to pay a multitude of taxes based on the size of that expense. Even if my profit at the end of the fiscal year is $0 and I pay zero income tax. Other examples include sales tax, local payroll or revenue taxes, property taxes, and licenses.

The term "tax" isn't limited to "federal income tax" and there is no reason why we can't tax hospitals further.Employees are taxed. Why would you say they are not?I did not say they are not. I said, you can think of it as an additional tax on the employees, if you have trouble wrapping your mind around the concept of taxing a business that makes no profit.I don't know many businesses who would serve the customer I served all night last night, for free. I don't know of any which would frankly. Oh, and make not stupid inference that I worked for free. I did not work for free, I charged the hospital a LOT of money to work for them, and her, all night long. Same with the doc, he charged the hospital a LOT to keep this homeless woman alive.What the hell are you talking about? Who said you should work for free?

Here's another example of cutting costs, without compromising health care. Of course it means an eventual cut in pay for Fyyr and his cronies, as fewer procedures are performed. But the money has to come from somewhere.

http://www.nytimes.com/2007/07/12/health/policy/12care.html<b>Shift in Health-Cost Focus Is Said to Show Promise </b>

By coordinating care and keeping their patients out of the hospital, doctors can help reduce overall health care spending, Medicare officials said yesterday in announcing the results of an experiment that allowed doctors to share in the cost savings.

The experiment, which started in April 2005 and is to continue through April 2008, is an attempt by Medicare to rethink the way it reimburses doctors. <b>The goal is to pay them for the quality of the care they deliver, rather than on how many tests and procedures they perform.</b>

“We want to reward providers for the right care at the right time,” said Herb Kuhn, acting deputy administrator for the Centers for Medicare and Medicaid Services, who said he was “very, very pleased with the first-year results.”

Although there are sharp limits to the conclusions that can be drawn, Medicare officials and the doctor groups involved say the experiment shows the potential in encouraging doctors to provide care and counseling programs that help patients stay out of the hospital or emergency room by better managing chronic conditions like diabetes or heart disease. “It’s where the Medicare program has to go,” Mr. Kuhn said.

While all of the 10 physician groups participating in the experiment improved their care for patients during the first year, according to the measurements in place, only two earned bonus payments. Those two, the University of Michigan Faculty Practice and the Marshfield Clinic in Wisconsin, were paid a total bonus of $7.3 million for saving Medicare $9.5 million. The bonus was in addition to Medicare payments for their usual services.

All 10 of the participants are large sophisticated organizations, with substantial experience in electronic health records or other systems known to improve patient care. <b>And the fact that eight of them did not meet the bonus threshold indicates how difficult it may be for Medicare to develop a payment system giving most doctors, many in small, less modern practices, a true financial incentive to improve care.</b>

edicare compared the hospital and doctor bills for the 224,000 patients being treated by the 10 groups with the bills from other doctors and patients in the same geographic areas to determine whether there were financial savings to the government. The doctors also had to meet certain quality criteria, like the basis of 10 clinical measures involving diabetes care.

For the second year, clinical measures for heart disease will be added. And in year three, measures for hypertension and basic preventive care for all patients will be assessed.

While Medicare said it had not yet calculated the experiment’s overall savings, the physician groups say they together saved the program about $21 million.

In subsequent years, “we expect greater savings will be generated, and the majority of practices will be receiving a bonus,” said Mark Selna, a physician with Geisinger Health Systems, a Danville, Pa., system of hospitals whose doctors are participating in the experiment.

Although Medicare and the doctors’ groups are still analyzing the information for the first year, many of the programs put in place seem to have resulted in fewer hospitalizations. Among its efforts, for example, Marshfield started a program in which eye exams for diabetes patients could be performed at a local doctors’ office rather than requiring a trip to a specialist. The clinic, which is based in Wisconsin, says it has reduced hospitalizations for its diabetes patients by about 13 percent in mid-2007 compared with 2004.

Other successful measures include simple follow-up. The University of Michigan group is having a nurse or nursing assistant call patients who have been discharged from the hospital or emergency room within 24 hours, making sure they understand the drugs they need to take or that, for example, a visiting nurse came as scheduled.

“It’s filled a huge gap in care,” said Dr. Caroline Blaum, the physician leading the effort at the university.

I'd be careful of that target based doctoring. In the UK they've done a similar thing and it has increased preventitive care. However doctors know that they get a bonus for prescribing blood pressure tablets (say) to their elderly patients so they do it, for all of them. The actual medical need of the patient tends to be substituted for doctoring by pay-scale targets.

It's not entirely bad but I'm sure there's a price to paid somewhere for such a dogmatic approach.

No Fyyr, it's you who has no idea what he's talking about. Business are taxed all the time on expenses and factors not tied to their profit.
I have no idea what you or he are talking about.

You say that the hospital is like every other business. I suppose if my customer last night walked into the liquor store and asked for 10K worth of vodka, they would hand it over, and write it off. Or the cigarette store, 10K worth of smokes, and just write it off. Or even The Drake, downtown...if she walked in and asked for the Penthouse for a week, they would just go ahead and put her up, and write it off. Not to mention the fact that by doing what we did, we just saved her life...icing and frosting.

For example, my employees are an expense, yet I still have to pay a multitude of taxes based on the size of that expense. Even if my profit at the end of the fiscal year is $0 and I pay zero income tax. Other examples include sales tax, local payroll or revenue taxes, property taxes, and licenses.
Well, the primary reason an organization is a non profit organization is to avoid Federal corporate tax. Since the non profit designation is what seems to be the point of contention, it seemed logical that it was that tax we were discussing.

Of course the hospital pays other taxes before that point. And thus are treated themselves as expenses. If you throw in additional taxes, they will just be written off and passed on to the consumer. IE a zero gain(except for whatever agency now gets that revenue). You are not cutting costs, you are just shifting money around, with the commensurate overhead and administration costs(bureaucracy) added on top of it.

Unless you are saying that the employees should take a pay cut to pay for your proposed tax. That it should come out of their paychecks and wages.

Actually, if that happened, I would just charge more for my labor, which would then be inevitably passed on to the consumers.

The term "tax" isn't limited to "federal income tax" and there is no reason why we can't tax hospitals further.I did not say they are not. I said, you can think of it as an additional tax on the employees, if you have trouble wrapping your mind around the concept of taxing a business that makes no profit.
I have already addressed that.

It is already taxed, by having to provide services mandated by Federal law, EMTALA, without recompense. If your definition of tax is that lenient, that too is already a tax. One that has put thousands of ERs and hospitals out of business.

What the hell are you talking about? Who said you should work for free?
Well, that really was what it sounded like you are saying. That it does not count that a company does something charitable, if the employees of that company actually charge the company for their labor, in the process of that charity.

And what is your rationale that I, as an employee of a non profit, should have to pay more tax than an employee of a for profit? I save people's lives and keep them alive, and you want to tax me more than say, a shoe salesman or cable guy or programmer? What is your rationale?

Um, doctors don't make anything for labs and tests around here.

I just had a draw for a lipid panel and testosterone level this afternoon, my ordering doc(PA really) makes nothing on the deal. I paid the testing company directly, my doc did not get it.

When docs in our hospital order tests, they get none of it.


Do you people think that docs get the money for the tests that they order? Is that what some of this is about?

Well, I mean the radiologist who reads the Xray gets paid for the test, but he did not order the test. He just reads the Xray, and gets paid for doing so.

How do you rationalize taxing a business that makes no profit more than a company that makes a profit for its owners?

y company takes what would otherwise be profit, and writes it off each year in indigent services.

Other for profit companies take that same money, and sends it out to their shareholders as dividends.

And you think that the company who puts it into giving poor people free healthcare should be taxed more than the hospital which pockets the difference instead.

I want a crony.


I really do. Where do you get them?

You have to be wealthy, famous, good-looking or powerful to have cronies. :p

However Crones are easy to get.

And actually, now that Tudamorf has explained that he was not referring to Federal Corporate taxes at all, but other taxes, it makes the discussion more fun.

Take for example Sales Tax. The State of California, Franchise Tax Board, the entity which taxes sales tax and income tax, views all California residents and companies as their own vassels, their own little revenue generating plants, which they own, their franchises. Just like the NFL owns the Oakland Raiders, just like the MLB owns the Oakland A's.

But what the Franchise Tax Board does is kinda interesting. They charge sales tax on all taxable items to the BUSINESS(those that sell or rent stuff). Then they give that, and each business the ability, the right if you will, to pass that cost to the customer.

In California, you as a consumer don't really have to pay sales tax, if you don't want to. It is just that the business you do business with, charges that to you...passes it to you. If you don't want to pay the tax, then the business just does not have to sell the stuff to you. There is no law saying that you, the consumer, have to pay the tax. You don't.

Additionally, what a lot of California taxpayers don't know, is that if you keep records of all your sale taxes that you do pay, then you can write them off, both on your Federal, as well as your California income taxes.

Whether you are an individual, or a business. What you pay in sales tax, is tax deductible.

The point is, that if you tax hospitals, (or any type of business)(or healthcare workers in general), they will just pass the cost back to the consumers and payers. You will just end up paying it again, with overhead tacked onto it. (That is exactly what EMTALA does).

Taxing hospitals, or healthcare workers to LOWER healthcare costs is about the most retarded thing I have ever heard. Finally glad that I figured out what you were really saying, Tuda.


And you know what, Tuda. When you switch the topic from the actual Diet to the Marketing of the Diet, which are two different things, without mentioning it to the rest of us, that is just foul. You have done this before. I don't know what you stand to gain in the discussion, when you know full well, I am talking about the Diet, while you over there are talking about its Marketing.

You have to be wealthy, famous, good-looking or powerful to have cronies. :p

How much are the ones like Dick Cheney who shoot lawyers in the face?


I want those kind especially.
I am not rich, but I am a hell of a lot better looking that Bush.

You say that the hospital is like every other business. I suppose if my customer last night walked into the liquor store and asked for 10K worth of vodka, they would hand it over, and write it off.You don't give away free services because you're nice guys, you do it because we make you. If you don't give them away, we'll point our guns at you and force you to shut down.

It is just another expense, a means to making more money. And you wouldn't be the first business to give away stuff in order to reap a greater long-term reward; everyone does it.

So yes, you're just like any other business, and you have no right to raise a non-profit flag as a reason you shouldn't be taxed.Unless you are saying that the employees should take a pay cut to pay for your proposed tax. That it should come out of their paychecks and wages.Of course it will come out of their paychecks and wages. Such a provision will, of course, include provisions that prevent the hospital from just raising rates to cover the new tax.And what is your rationale that I, as an employee of a non profit, should have to pay more tax than an employee of a for profit?Because you make too much money for the service provided. (Well not you personally, as much as the doctors.)

Um, doctors don't make anything for labs and tests around here.

I just had a draw for a lipid panel and testosterone level this afternoon, my ordering doc(PA really) makes nothing on the deal.If the test weren't necessary, that time you spent drawing the blood also wouldn't be necessary. The doctor's time in reviewing the results and speaking to the patient wouldn't be necessary either.

ultiply that by every unnecessary test you run, and it adds up to lots of unnecessary man-hours.

Now add in all the people who need not be treated in the hospital in the first place, and you have a ton of man-hours.

Those are hours that you are being hired for and paid for.

How do you rationalize taxing a business that makes no profit more than a company that makes a profit for its owners?Because you charge too much, both compared to similar countries (U.K., Canada) and to other fields.

I went for a doctor's office visit at UCSF for 10 minutes, that was just talking and writing. The hospital would have charged over $200 had my insurance company not paid the bill.

There is no other professional degree that routinely nets $1,200 per hour. For example, a top lawyer (we're talking decades of experience, prestigious firm) might charge $500 per hour.

Additionally, what a lot of California taxpayers don't know, is that if you keep records of all your sale taxes that you do pay, then you can write them off, both on your Federal, as well as your California income taxes.For most people (who itemize), it's better to deduct state tax than sales tax. Especially California tax, that's a whopper, such as for you overpaid health care types. Well, at least my health care stocks are picking up.

Because you charge too much, both compared to similar countries (U.K., Canada) and to other fields.
I don't charge enough.

How much would you charge to remove maggots from a woman's vagina to put a foley catheter in?

I went for a doctor's office visit at UCSF for 10 minutes, that was just talking and writing. The hospital would have charged over $200 had my insurance company not paid the bill.
You went to the wrong doc. My last doctors visit cost me 72 bucks.

There is no other professional degree that routinely nets $1,200 per hour. For example, a top lawyer (we're talking decades of experience, prestigious firm) might charge $500 per hour.
And tell me, how many lawyers keep a person alive, when they would otherwise die? I do that for less than a 10th of your lawyers cost.

I don't charge enough.There are countless doctors and nurses in Canada and the U.K. who would disagree with you. Last I checked, they were doing way better in the life expectancy department, too.

If the test weren't necessary, that time you spent drawing the blood also wouldn't be necessary. The doctor's time in reviewing the results and speaking to the patient wouldn't be necessary either.
Of course the tests are necessary. I asked for them.

I would fire a doc, if he did not order the tests I wanted run.

ultiply that by every unnecessary test you run, and it adds up to lots of unnecessary man-hours.
I have never ordered an unnecessary test.

Now add in all the people who need not be treated in the hospital in the first place, and you have a ton of man-hours.
Well, then they should not be going to the hospital in the first place. I agree with you there.

Those are hours that you are being hired for and paid for.
I don't know what you are saying.

There are countless doctors and nurses in Canada and the U.K. who would disagree with you. Last I checked, they were doing way better in the life expectancy department, too.

Huh?

Well, I work with Canadian nurses, eh.

What is your point, eh?

I don't know what you are saying.Without all the extra busy-work generated by these unnecessary hospital visits, tests, and so on, you would face stiffer competition for a smaller pool of jobs and/or would be paid less.

You don't give away free services because you're nice guys, you do it because we make you. If you don't give them away, we'll point our guns at you and force you to shut down.

Well, the tax law is designed to motivate people to give stuff up for charity, in the first place. Whats your point?

That unless people give stuff up for charity, AND pay taxes on what they give, that they are bad or evil people?

It is just another expense, a means to making more money. And you wouldn't be the first business to give away stuff in order to reap a greater long-term reward; everyone does it.
Of course everyone does it. Just no other type of business does it keeping people from dying. But of course, you belong to the believers that the more people who die, the better off life is for those who live. It is a true thought and notion. Can't deny it, it is the truth. /shrug.

So yes, you're just like any other business, and you have no right to raise a non-profit flag as a reason you shouldn't be taxed.
Corporate net income tax?


Of course it will come out of their paychecks and wages. Such a provision will, of course, include provisions that prevent the hospital from just raising rates to cover the new tax.
Commie!

Because you make too much money for the service provided. (Well not you personally, as much as the doctors.)
You obviously have no idea what service I provide.

Without all the extra busy-work generated by these unnecessary hospital visits, tests, and so on, you would face stiffer competition for a smaller pool of jobs and/or would be paid less.

You gonna change that?

You gonna change tort. And Malpractice.

I could double my workload without just those alone.

Half my labor I do, is protecting against lawsuits. Only half is patient care.

If you could kill all the lawyers, You would put half of all the nurses in the US out of a job. We really do work our asses off, and fast. I could easily take care of 20 patients a shift, if I did not have to chart extraneous infos, to protect myself and the hospital against future lawsuits.

Well, the tax law is designed to motivate people to give stuff up for charity, in the first place. Whats your point?My point is that your non-profit status is irrelevant to this discussion, and you should not have brought it up in the first place.

Unless you can point out some logical reason why it should be relevant.

ps, I don't make any money off of tests.

All they mean to me, is that I have interventions to do.

Your hemoglobin is 8. I am sure I need to give you some blood.

Your K is 2.6. I am going to spend the whole night giving you KCL.

Tests only mean more work for me. Not more money.

You gonna change that?

You gonna change tort. And Malpractice.

I could double my workload without just those alone.I think we already agreed that tort reform is a significant part of this.If you could kill all the lawyers, You would put half of all the nurses in the US out of a job.If we killed off the civil legal system entirely, there would be no incentive for you to uphold your part of the contract.

No, we need it in place, but we need to limit recovery to economic damages and legal expenses only. Just as in any other regular business litigation case.

My point is that your non-profit status is irrelevant to this discussion, and you should not have brought it up in the first place.
It is a fact. Of course, I should bring it up. Our hospital does not distribute profits to shareholders. That is what I said.

Whats your fn problem?

Unless you can point out some logical reason why it should be relevant.
Because it is NOT making any profit. What planet are you from?

Tests only mean more work for me. Not more money.More work IS more money.

No, we need it in place, but we need to limit recovery to economic damages and legal expenses only. Just as in any other regular business litigation case.

Half the nurses in the US would not be needed at all, if they did not need to chart to protect against future lawsuits.

Or differently put.

If nurses did not have to chart, just for future lawsuits, they could provide DOUBLE the amount of care per patient.

It is a fact.A fact that's irrelevant to this discussion.Because it is NOT making any profit.And the taxes having nothing to do with profit.

More work IS more money.

I am hourly.

Just means I have to work faster when there are tests. I don't get paid more.

And neither do docs, I told you that.

If nurses did not have to chart, just for future lawsuits, they could provide DOUBLE the amount of care per patient.And if they had no incentive to uphold their part of the bargain, how much quality patient care would they provide?

I am hourly.

Just means I have to work faster when there are tests. I don't get paid more.

And neither do docs, I told you that.If you work 10 hours now, and because of the reforms you only had 5 hours of work to do, guess what would happen.

And if they had no incentive to uphold their part of the bargain, how much quality patient care would they provide?

Um, docs and nurses provide care LONG before they were ever sued by lawyers.

I get a little epinephrine jizz every time someone who would have otherwised died, lived because of my interventions or those of the team.

I don't get that when they die.

Are YOU really really saying that docs and nurse would not do their jobs unless there were lawyers making sure they did their jobs? YOU?

I will tell you, honestly, I don't need that as motivation, I assure you. It is only extraneous. Maybe others do, the whole entire extraneous other half of nursing needs that(I doubt it). /shrug.

If you work 10 hours now, and because of the reforms you only had 5 hours of work to do, guess what would happen.
I work 12 hour shifts.

Over half that time is meant to be spent charting. To protect against future lawsuits.

10 hours are for weanies.

You 8 hour people are fcking pussies.

More work IS more money.

No, it means more work.

I still make the same per hour.

Are YOU really really saying that docs and nurse would not do their jobs unless there were lawyers making sure they did their jobs? YOU?In a sense, yes, there has to be legal recourse if you break your part of the bargain. If you screw up your job and I lose money (including what I paid you), I want a way of getting that money back.

It would be nice if we could all just count on the good of our fellow man (and, barring that, market forces), but history has proven to us it can't work that way.

I thought you LIKED freedom of contract, which necessarily includes the right of enforcement of contracts.I will tell you, honestly, I don't need that as motivation, I assure you.You just said that you wouldn't work for a penny less, so obviously that warm and fuzzy feeling is not your only motivation.No, it means more work.

I still make the same per hour.If you can process 20 patients in one twelve hour shift, then if you suddenly have 10 patients, you will be expected to finish them in six hours. You can't just pad and think no one will notice.

Anyway, back on topic.

What kind of things could be put in place to limit abuse of the system, if healthcare became free.

1) We have one proposal to tax hospitals. Alternately tax healthcare workers.
2) We have one proposal to make people wait longer for interventions and procedures.

Do we have any proposals that actually sound like it is not making a broke system worse?

What kind of things could be put in place to limit abuse of the system, if healthcare became free.What constitutes abuse of the health care system? The average person avoids going to a hospital; they're only there when their condition requires it.

That leaves nutjobs and drug seekers, which can be filtered out on a case-by-case basis.Do we have any proposals that actually sound like it is not making a broke system worse?Yes. Read the article above about the Medicare study. The only problem is selling the idea to hospitals, who are going to lose money on account of far fewer customers.

What constitutes abuse of the health care system?
Abuse. Using it too much.

The average person avoids going to a hospital; they're only there when their condition requires it.
No they don't. They use to. But people come to the hospital now for minor thing that they should go to their doctors for.

They don't have doctors, of course. So they come to the hospital. That is what is breaking the system now, too many people coming to the hospital running up bills they cannot pay. That cost is past on to the current payers, increasing the cost of their insurance.

That leaves nutjobs and drug seekers, which can be filtered out on a case-by-case basis.
We can't filter them now. It is against the law. Are you going to repeal EMTALA?

Yes. Read the article above about the Medicare study.
Ok, the one thing I read that it want to do, is that we don't run any more unnecessary tests.

/shrug

What is an unnecessary test?

The only problem is selling the idea to hospitals, who are going to lose money on account of far fewer customers.
You honestly think that by giving free healthcare to 50 million more Americans, that they hospitals are going to get fewer customers. That is idiotic.

When 50 million more Americans start going to the ER for gas and hangnails,,,,you think the system is broke now?

What is an unnecessary test?

You come to me saying that you have chest pain. How about you tell me what is wrong with you. Do you know what it is?

e? I think you are having an heart attack first. I run a cardiac enzymes test. If it comes back negative, and you are not having a heart attack, that's what the test was for. To tell you when something is not something. It could be an MI or Munchausens. Why didn't you just tell me it was Munchausens?


Oh, now I just figured it out. You think it is like House and Greys Anatomy. NM.

Abuse. Using it too much.

Who do you think should be the one to decide wether or not an individual needs medical assistance?

Better yet, let me give you a case study instead. You get to call what tests are necessary.

A woman is brought into the ER by her husband.
She is 45 years old.
She has no teeth. Visibly unkempt in appearance, and smells of urine and ETOH.
Her sclera are notably yellow tinged.
Her temperature is 38 degrees.
Her heart rate is 140.
Her blood pressure is 65/42.
She is vomiting blood, and complaining of abdominal pain. The emesis looks like coffee grounds.
Her abdomen is notably barreled in morphology.

Her husband states that they are homeless and neither of them have jobs or insurance. Additionally he states, this is worse this time than the last time.

What is your next step, Tudamorf or any of you? What does she have? What tests are you going to run? But only necessary ones, remember.

Who do you think should be the one to decide wether or not an individual needs medical assistance?
I am asking you.

I am asking you really, if you know what abuse is, or what it looks like.


It is obvious so far that none of you do. So far it seems like asking a blind person if a Nagel is art or not.



Regardless of that point, I do think that those who are paying for the service should have a say as to how it is being spent. For it really is their money afterall.

No they don't. They use to. But people come to the hospital now for minor thing that they should go to their doctors for.Because they have no other choice. Because we don't allow them to see doctors for free.

It's not as if they come to the ER because they really love waiting 5 hours in a room with a bunch of very sick people to get treatment. If there were a faster and easier way, they'd use it.

This is one aspect that can be easily fixed.You honestly think that by giving free healthcare to 50 million more Americans, that they hospitals are going to get fewer customers. That is idiotic.We are NOT increasing the number. Everyone already has free health care, just in a screwed up and inefficient way. We are trying to make it more efficient while keeping the number constant. And efficiency will hurt your bottom line.What is an unnecessary test?I don't know. But YOU, and the doctors around you, know.

And instead of micro-managing your tests, I'm simply going to change the way you get paid. Instead of rewarding you for busy work and padding, I'm going to pay you by the quality of the finished product. Then, you will naturally drop the unnecessary tests, visits, and other busy work, as in the Medicare study.

Regardless of that point, I do think that those who are paying for the service should have a say as to how it is being spent. For it really is their money afterall.

Here's a concept you need to wrap your brain around, and accept:

It WILL cost more money to provide health care to more people than what's done now.

If that fact doesn't sit well with you, then you either need to work on accepting it, or you need to just accept that you'll never be in favour of providing it.

Until you've decided where you stand on that very basic issue, you'll always be confused when debating it.

It WILL cost more money to provide health care to more people than what's done now.You're wrong, Tinsi.

We now spend twice as much per capita on health care as Canada does, and they have universal health care.

Our system is just extraordinarily wasteful; we can clean it up, give everyone coverage, and still have money to spare at the end of the day, if we really want to. Maybe one day our life expectancy will even approach that of the Canadians.

You're wrong, Tinsi.

We now spend twice as much per capita on health care as Canada does, and they have universal health care.

Uops, I sit corrected. Is that based on treatment cost only? Or is research etc factored in? You are, after all, the world's leader in that regard, and I'm sure that isn't cheap.

Is that based on treatment cost only?Actual public spending to treat patients. When you factor in private spending, the situation is even uglier; we spend almost 4x as much as Canada does.

Some background info: http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #Price_of_health_care

Yes, our system really is that screwed up. And it's going to be difficult to convince the small minority who reap that huge financial windfall (Fyyr et al.) to change their ways.

I swear I'm not making this stuff up. Have a look, and these are studies from 1999, before the current health care crisis (20% increase in health insurance premiums per year, etc.):

https://content.nejm.org/cgi/content/abstract/328/11/772Expenditures per capita for hospitals are higher in the United States than in Canada. If the United States had the same spending pattern as Canada, the annual savings in 1985 would have exceeded $30 billion.

. . .

After all adjustments, the estimate of resources used for inpatient care per admission was 24 percent higher in the United States than in Canada and 46 percent higher in California than in Ontario.

. . .

Canadian acute care hospitals have more admissions, more outpatient visits, and more inpatient days per capita than hospitals in the United States, but they spend appreciably less. The reasons include higher administrative costs in the United States and more use of centralized equipment and personnel in Canada.

http://content.nejm.org/cgi/content/abstract/349/8/768In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.
If you come from a country with a normal health care system, you might be surprised to learn that we force people who need even the most mundane treatment to go to an ER, rack up $10,000 in expenses for a prescription and a bandage, and bill the government. And the hospitals are laughing all the way to the bank.

So, no takers on the case study?<pussies>

Thought so. I wonder why.


Anyways, any other concrete suggestions on cutting abuse when healthcare becomes free to everyone; AND EVERYONE VIEWS IT AS A RIGHT AND ENTITLEMENT(duh).

1) Longer waits for appointments.
2) Tax hospitals and hospital employees.
3) Cut the number of tests.
4) Change the way hospital employees get paid(whatever that means, I dunno)


Anything better than those? Anything other than those?

You forgot the tobacco tax and fat tax. Tax the activities that cause people to go to the hospital in the first place.

For Fyyr's case study:

Obviously, you and I know that this woman is end-stage liver failure, whether from alcohol abuse or Hep C it doesn't really matter. So, clean her up, give her some fluid, some Sandostatin to stop the varicele bleed and some nutrition to help her feel better. Tests? Well... probably a CBC to see if a tranfusion is necessary but really what tests are needed? Knowing that when she is discharged to street (since she is homeless) she will continue her unhealthy behaviors of drinking it is unrealistic to think we can stop that. I am in favor of putting her on an alcohol drip to stave the withdrawl that will most likely cause her to have a stroke or heart attack. Most doctors would rather just load her up with librium or Ativan for the withdrawl, send her out to have her return within 2 weeks in the same condition.

As for Tudamorf's comparison to Canada's healthcare system... just because they spend less money doesn't mean their healthcare is better. If you are 65 years old and break your hip - you could wait up to 6 months to have it fixed. Any elective surgery is put on a waiting list. There are a myriad of things wrong with the US's healthcare system, but the competition we have amongst the hospitals and healthcare professionals is what keeps our healthcare top of the line. When there is no competition, there is no reward for doing it better.

If the wait times are anything like what has been described I seriously doubt many Americans would be interested in that system. How are you supposed to live for 6 months with a broken hip and how can that be justified? It seems to me an older person's (or anyone's) total health would simply deteriorate faster all around while being forced to be inactive in that situation.

Any of our friends who have universal health care wish to comment on the usual wait times for seeing a doctor when accidents or illness occur?

As for Tudamorf's comparison to Canada's healthcare system... just because they spend less money doesn't mean their healthcare is better. If you are 65 years old and break your hip - you could wait up to 6 months to have it fixed. Any elective surgery is put on a waiting list. There are a myriad of things wrong with the US's healthcare system, but the competition we have amongst the hospitals and healthcare professionals is what keeps our healthcare top of the line. When there is no competition, there is no reward for doing it better.

Canadians can always spend their extra money getting a hip replacement through private medicine. Public provision does not exclude that. The private sector always has to excede the public provision to get business.

How are you supposed to live for 6 months with a broken hip and how can that be justified? It seems to me an older person's (or anyone's) total health would simply deteriorate faster all around while being forced to be inactive in that situation.

y mother is over 80 and has had two hip replacements through a national health care system. She had to wait a year for the last one. She of course had the option of paying for one or both privately, but like most people she chose to wait.

In fact, when you consider that my parents could have paid for private operations for gall stones, mastectomies, thyroid problems, as well as equipment like hearing aids, wheelchairs, medicines etc, they could actually have run up rather large medical bills. They're probably uninsurable. As it stands they have good quality of life.

Yes, Maddie said "break your hip", but then went on to say elective surgery. I suppose if someone does fall and actually breaks their hip they would be seen on an emergency basis as opposed to someone whose joint has worn out and needs a hip replacement.

y uncle recently had hip replacement but he was still able to be up and move around even with the pain until he had the surgery.

As for Tudamorf's comparison to Canada's healthcare system... just because they spend less money doesn't mean their healthcare is better.If they spend half the money, and achieve similar long-term results (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #Health_care_outcomes), they are better.There are a myriad of things wrong with the US's healthcare system, but the competition we have amongst the hospitals and healthcare professionals is what keeps our healthcare top of the line. When there is no competition, there is no reward for doing it better.Competition is not necessarily a function of the funding source. Very few Americans actually pay for their medical care; mostly it's from some combination of the government or an insurance company. Your 65-year-old with the broken hip would probably be relying on government funding.

And while the United States does have many high end hospitals, I see no compelling evidence that the average facility here is significantly superior to those in Canada or the U.K.

You forgot the tobacco tax and fat tax. Tax the activities that cause people to go to the hospital in the first place.

How does that help prevent abuse of free healthcare?

How does that help prevent abuse of free healthcare?It pays for it. And the "abuse" is what's going on right now.

If you include the risky behavior of smoking and eating, how about these types too?

http://www.msnbc.msn.com/id/19785205/

How about running with the bulls?

Should these two brothers pay for their own healthcare directly because they did this on purpose.

How about these guys?
http://www.jackassmovie.com/

Not only are they constantly using the healthcare system to fix themselves, they are motivating other jackasses to do the same thing.

One more word for you: "athletes"

This is an NIH article about extreme sports on hospitals.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16163995&dopt=Abstract

The study was done in Britain, but the effects should be the same.


Cheerleading
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=16396869&dopt=Abstract
20,000 hospital affected injuries in a year.

I didn't even know Rugby was all that big in the US.
An estimated 236 539 rugby players presented to US emergency departments from 1978 through 2004.
From http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1569558

One more word for you: "athletes"Athletes also generate a ton of economic activity, though.

As for risky hobbies -- ones that don't generate income -- yes, I'd like to see taxation if it causes enough stress on the health care system that is financially equivalent to the consequences of smoking and obesity.

However, micromanaging every little risky venture is pointless and inefficient.

Tobacco generates lots of economic activities too, so does food.

However, micromanaging every little risky venture is pointless and inefficient.

Although no one suggested it, glad we agree ;)

Tobacco generates lots of economic activities too, so does food.Not enough to outweigh the cost.

If you are going to tax it to outweigh the costs...

How can it not outweigh the costs?


Dude, you are not even fun anymore. You are beginning to sound like SF. But at least he is fun. Simple but fun.

How about Skiing.

Or car driving.

Both very high cost hospital medical wise endeavors. You gonna tax them extra too. Of course Skiing already has a 50% tort tax applied. Might as well make it 100%, I suppose.

How about buckets, kids drown in buckets every day of the year? Not all of the die, most of them require major medical interventions. Tax buckets?

If you are going to tax it to outweigh the costs...

How can it not outweigh the costs?The magnitude of the cost is the trigger. Taxing every little thing is impractical. Taxing a few really big things that put a huge burden on our medical care system is not. All the little things can get swept up into a general tax.

The magnitude of the cost is the trigger. Taxing every little thing is impractical. Taxing a few really big things that put a huge burden on our medical care system is not. All the little things can get swept up into a general tax.

http://www.youtube.com/results?search_query=cheerleading+accident&search=

If you can tax a pack of cigarettes, it is just as easy to tax pom poms(or cheer uniforms). Hardly impractical, taxing stuff is easy to do.

And magnitude?, how about taxing parents who want to have their 24week gestation babies saved at all costs. NOW those people are an extreme cost on the system, for their whole lives. Not to mention the million dollars or so just to bring them up to 40 weeks. Most(if not just many) of them will have CP, and need care, sometimes 24 hour care, for the rest of their lives.

http://www.youtube.com/results?search_query=cheerleading+accident&search=

If you can tax a pack of cigarettes, it is just as easy to tax pom poms(or cheer uniforms). Hardly impractical, taxing stuff is easy to do.It's impractical when you get down to that level of micromanagement. Just the administration of a million little miscellaneous taxes would probably cost us more than the injuries cost now.

When pom poms begin to cost our health care system $75+ billion, we'll talk. In the meantime, let's stick to cigarettes and fat people.And magnitude?, how about taxing parents who want to have their 24week gestation babies saved at all costs. NOW those people are an extreme cost on the system, for their whole lives. Not to mention the million dollars or so just to bring them up to 40 weeks. Most(if not just many) of them will have CP, and need care, sometimes 24 hour care, for the rest of their lives.Now you're crossing the line from taxing voluntary and risky activities, to taxing bad luck.

Yes, if a reckless driver slams into you, or if you're the accidental victim of a drive-by shooting, you're going to cost the system a lot of money. But you shouldn't be blamed for it.

Sure, perhaps in retrospect you could've stayed off that road, or moved into a nicer neighborhood, but you didn't directly engage in a risky activity, such as driving drunk yourself or joining a gang.

I would draw the line at pure voluntary and non-essential activities and go no further.

Now you're crossing the line from taxing voluntary and risky activities, to taxing bad luck.

No!

This is a matter of choice.

The choice belongs to the parents to treat these extreme preemies. We don't have to. The treatment of these extreme preemies is purely voluntary.



But you don't know that do you. I also bet that you don't know how common it is.

This is a matter of choice.

The choice belongs to the parents to treat these extreme preemies. We don't have to. The treatment of these extreme preemies is purely voluntary.We're talking about the activity that might lead to treatment, not the treatment itself.

Obviously the treatment itself is voluntary. We could just go Spartan and toss them off a cliff.

The underlying assumption in this discussion is that those who need life-saving treatment should get it. If you want to change this assumption, it's an entirely different discussion.

Well, you still have to draw a line somewhere, especially when saving one life means denying life to others due to finite resources.

Well, you still have to draw a line somewhere, especially when saving one life means denying life to others due to finite resources.What are you talking about? We cross that line every day.

That means the current line is drawn poorly or incorrectly.

What I'm saying is that it is impossible for everyone to get life-saving treatment that needs it, when the sum of resources needed to provide that treatment exceeds the total resources available. Thus, it is necessary to deny some life-saving treatment to some people.

This is all in response to:
The underlying assumption in this discussion is that those who need life-saving treatment should get it.

What I'm saying is that it is impossible for everyone to get life-saving treatment that needs it, when the sum of resources needed to provide that treatment exceeds the total resources available. Thus, it is necessary to deny some life-saving treatment to some people.We have not gone there yet, because there are enough resources to treat those who arrive at a hospital.

But we let people die or suffer every day, simply because we're too cheap to do anything about it. Ironically, by doing so, we may end up spending more in the long run to treat them at hospitals.

Providing(not) million dollar heroic interventions <> tossing babies off a cliff

If Spartans gave birth at 24 weeks, it was a miscarriage.
Just like it was for your grandmother. Or great great grandmother. Mother or aunt.


The underlying assumption in this discussion is that those who need life-saving treatment should get it. If you want to change this assumption, it's an entirely different discussion.

The level and cost of care are intrinsic to this discussion.
Who gets care and who does not get care is intrinsic to this discussion.
And when.

The level and cost of care are intrinsic to this discussion.
Who gets care and who does not get care is intrinsic to this discussion.
And when.Well, everyone who shows up at a hospital is already entitled to stabilizing treatment under the current system. The premise behind any new system is that it will incorporate that same basic feature.

If you want to regress to a system where alphas get treatment but deltas don't, that's a different discussion.

If it were possible to give everyone the treatment they were entitled to, then wouldn't triage be unnecessary?

And I see absolutely no relevance to Brave New World here. No one here is proposing selecting people for treatment based on caste or standing in society or anything like that.

If you have 1 million man-hours in resources, and you have one person that needs 1 million man-hours worth of treatment to survive and 1,000 people that need 1,000 man-hours of treatment to survive, the choice is obvious (to me), no matter who the people are.

(Edit: Changed money to man-hours to better illustrate the point. At some point money is no longer the limiting factor.)

If it were possible to give everyone the treatment they were entitled to, then wouldn't triage be unnecessary?No. You can triage, yet still give everyone the treatment they need.And I see absolutely no relevance to Brave New World here. No one here is proposing selecting people for treatment based on caste or standing in society or anything like that.Fyyr is.If you have 1 million man-hours in resources, and you have one person that needs 1 million man-hours worth of treatment to survive and 1,000 people that need 1,000 man-hours of treatment to survive, the choice is obvious (to me), no matter who the people are.Right, but we don't have to make that choice at this stage.

http://news.yahoo.com/s/nm/20070717/sc_nm/bioethics_dc_1<b>When to let go? Medicine's top dilemma</b>

WASHINGTON (Reuters) - A terminal leukemia patient must have daily blood transfusions or die. A family begs doctors to do everything possible to keep their elderly mother alive. Parents cannot accept their newborn baby will not survive.

End-of-life issues top the list of ethical dilemmas hospitals face as medical progress enables doctors to extend an endangered life to the hard-to-determine point where they may actually only be dragging out death.

Private dramas like these play out in hospitals every day, rarely hitting the headlines as did the family feud over ending life support for Terri Schiavo in the United States in 2005 or a British couple's fight to save their severely handicapped baby Charlotte Wyatt in 2003 when doctors wanted to give up on her.

These patients used to just die naturally, but now it might be doctors, hospital ethics committees or courts that decide if and when to let them. The more science discovers, especially about the brain, the harder it can get to make that decision.

"The ability of medicine to keep people alive for such long periods of time -- despite their best efforts to die -- has changed the way people perceive the end of life," said Susan desJardins, a pediatric cardiologist and member of the ethics committee at Arnold Palmer Hospital in Orlando, Florida.

"We have to ask when to provide care, when to stop care, when care is futile," she said during a recent bioethics course for health care professionals at Georgetown University's Kennedy Institute of Ethics.

TECHNOLOGY AHEAD OF MORALS

Participants at the course were doctors, nurses, chaplains, social workers, administrators, lawyers and others, reflecting the mix of staff hospital ethics committees include to ensure these issues are thoroughly debated.

The nearby Washington Hospital Center has two trained philosophers for ethics consultations. At George Washington University Hospital, a special institute on spirituality and health studies faith and end-of-life issues.

"Our technology is ahead of our morals," said Washington Hospital Center medical director John Lynch. "From an ethical point of view, we haven't learned when to use our technology.

"The biggest problem here is futile treatment," he said. "That's when it's clear after some time that a patient, under normal medical circumstances, is never going to get better.

"People say there could be a million in one chance of recovery, but we can't work that way."

But when does it become useless to keep tubes feeding and hydrating a patient whose heart works but brain seems dead?

"Our hospital attempted a few years ago to write a policy on futility," Mary Ruckdeschel, a social worker from Barnes Jewish Hospital in St. Louis, said at the Georgetown course.

"We were never able to do this because people could not agree on the definition of futility."

DEALING WITH FAMILIES

Even if further treatment is clearly futile, worried families can have difficulty accepting that a loved one in intensive care will not make it through, several members of hospital ethics committees said at Georgetown.

"It's a tough one," said David Harness, Protestant chaplain at Baltimore's University of Maryland Medical Center.

"Rationally, you can understand there is brain death while the body is still functioning -- but it's difficult on an emotional level to separate those out."

Cheryl Fallon, a nurse manager at the intensive care unit in Queen's Hospital in Honolulu, was part of an ethics committee that decided it was futile to maintain daily blood transfusions for a woman just about to die from leukemia.

"The family went to another hospital and asked their ethics committee, which recommended they continue," she said. "So our attending physician continued them. She died two weeks later."

While that was exceptional, patients and families often find ways to continue treatment hospital staff might consider futile.

<b>"The two biggest manipulation tools that patients and family use are God and lawyers,"</b> said Nneka Mokwunye, director of the Center for Ethics at the Washington Hospital Center.

"They know that lawyers scare the bejesus out of doctors," she said, "and if the lawyers don't scare them, God will. If somebody says you must keep my loved one alive until God performs a miracle, they don't know how to respond to that."

"WE DON'T DO DEATH VERY WELL"

Recent research into the brain seems to be making it more difficult to say when a terminal patient is actually dead. It turns out that patients considered brain-dead may have a minimal consciousness left and therefore still be technically alive.

"The research seems to suggest that it's very difficult to distinguish the minimally conscious from the permanently unconscious," said Georgetown bioethics professor Robert Veatch.

"There is increasing skepticism that we can really know when someone is permanently unconscious."

Several bioethicists linked efforts to keep terminal patients alive by all means to America's cultural emphasis on staying young and healthy.

"In the U.S., I don't think we do death very well," said Dr Christina Puchalski of George Washington Hospital. "When people are faced with death, there is a big push on survivorship, to help people stay alive as long as they can. I don't think that's bad, but quality of life has to come into play."

Hospitals have been urging people for years to sign advance directives setting out what treatment they do or don't want near the end of life, but only about 15 percent have done so.

"Most Americans don't really believe they're going to die," Lynch said. "This is where so many of the problems start.Bolded part quoted for truth. Both "god" and lawyers should not play any significant role in our health care choices.

Well at least you are educating yourself to the issue.

What I'm saying is that it is impossible for everyone to get life-saving treatment that needs it, when the sum of resources needed to provide that treatment exceeds the total resources available. Thus, it is necessary to deny some life-saving treatment to some people.

It's necessary -providing- your statement regarding the resources is both correct and unchangable. Of course this is not the case.

If it's not the case, then why do I keep hearing about shortages of blood and organs for transplants and such?

If it's not the case, then why do I keep hearing about shortages of blood and organs for transplants and such?

That's a fixable problem.

That's a fixable problem.Yep, just take "god" out of the medical care system and you'll be overflowing with organs.

This is hilarious.

http://video.google.com/videoplay?docid=792949554138159445&q=Stephen+Colbert%2C+Michael+Moore&total=36&start=0&num=10&so=0&type=search&plindex=0