US ambassador killed over a film

[kandrathe]

Difficult decisions and uncomfortable discussions need to take place in our society.

< awkward silence >

... Absolutely.

My position would be that when "we" are paying we should be humanely willing to contribute a certain amount, and I'm not sure how you measure that. It could be per incident, or lifetime.

Here is an interesting article that resonates with me; The Rise In Health Care Spending And What To Do About It - by Kenneth E. Thorpe

He says, "The growth in real per capita health care spending is simply the growth in spending per treated case times the number of medical conditions treated (treated disease prevalence). Elsewhere my colleagues and I have apportioned the rise in spending over time into these two categories and concluded that approximately 63 percent of the rise in real per capita spending is traced to a rise in treated disease prevalence."

I think a key observation he makes that we all forget in the health care expense model is our individual responsibility for our own health. Frankly, based on the numbers he cites for morbidity, we've done a horrible job as keeping ourselves healthy.

What alarms me most about our current deficit spending (as describe in the article and the expanding elderly population) is not the money being spent on those without means, but the vast amounts being (blindly) spent on all people without regard to their outcome, or their means. So, the other side of this is that people need to be more accountable for their own health, and our focus on health care does nothing to address our unhealthiness and its societal cost.

I'm in the middle-middle class, and I'm probably not alone in observing that recent economic trends have put us in a much less favorable position. Even so, I don't as much mind being taxed to give a hand out to those that need a hand up. But, it chafes me a bit to think I'm feathering the nests of those in the US who are better off. I think we also hemorrhage money on stuff like foreign aid, wars and interventions.

Then, a close second would be the excessive amount of administrative overhead we endure. (One of numerous costs studies by Alan Sager, Ph.D. and Deborah Socolar, M.P.H.) "One-half of health spending goes to clinical and administrative waste, excess prices, and theft. Physicians can identify clinical waste. Careful cost controls should rest on physicians’ decisions about services needed by each patient. Pathology is remorseless but resources are finite, so trade-offs are essential. There are no blank checks. Trustworthy methods of paying doctors should minimize incentives to over- or under-serve. Variations on this approach have been called “bedside rationing” or “professionalism within a budget.”

I'd favor a rationed per treatment approach for both acute and chronic cases (heart disease, diabetes, etc.). Where possible, I believe there should be a standard care regime approved by general medical practice -- exceptions and variations would also need to be handled somehow. I don't think anyone should be denied any care they need. But, if they have the means, they should be expected to pay for the care they receive above and beyond a norm (even if they are old). This approach of shared accountability for patient and treatment works for private insurance or publicly funded -- I don't see that the issue of cost is related to who is paying, but rather that those who are paying are not holding the process accountable for the costs. We also need to tie some incentives for the patient back to the patients health -- It's probably too harsh to link it directly to payments, but health costs to BMI is an insightful study.