[cherdano]

Flem72, on 2017-July-05, 17:49, said:

Why do a bunch of NIH bureaucrats get to decide whether and/or where Charlie Gard dies? Why in the world do they have that power in the first place?

Philosopher kings and a state-run health care system. Screw 'em.

Charlie Gard is a tragic case, and I agree it is a problematic case.
I don't think it is a good source for trying to score cheap political points. But if you want to, you should at least put a very minor effort into getting the facts right. It would show a bit of genuine respect for this tragic case.

(Hint: NIH is the major funding agency for medical research in the US. It hasn't had anything to do with decisions about Charlie Gard.)

[Zelandakh]

Flem72, on 2017-July-05, 17:49, said:

Why do a bunch of NIH bureaucrats get to decide whether and/or where Charlie Gard dies?

My understanding is that the European Court of Human Rights made the ruling - but perhaps you have information that they were paid off by NIH....?

[Flem72]

cherdano, on 2017-July-06, 03:51, said:

Charlie Gard is a tragic case, and I agree it is a problematic case.
I don't think it is a good source for trying to score cheap political points. But if you want to, you should at least put a very minor effort into getting the facts right. It would show a bit of genuine respect for this tragic case.

(Hint: NIH is the major funding agency for medical research in the US. It hasn't had anything to do with decisions about Charlie Gard.)

my bad: NHS. That's a fact.

[Flem72]

Zelandakh, on 2017-July-06, 05:51, said:

My understanding is that the European Court of Human Rights made the ruling - but perhaps you have information that they were paid off by NIH....?

My understanding is that the Court upheld the bureaucrats' decision (as they were always going to do) under the administrative law apparatus in place as part of the regulatory structure of NHS.

The parents raised the money. The bureaucrats said they couldn't use it to get their child to the US to try the experimental treatment. The court essentially said that the bureaucrats' decision should be upheld -- as against parental rights (and, I might add, as against the concept of individual freedom from government oppression) -- under NHS administrative regulations. The system made the decision. Administrative law courts are part of the same bureaucracy whose decisions they review; try to win a lawsuit against EPA.

And then there is this: “The quality-adjusted life year or quality-adjusted life-year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health.”

[Zelandakh]

This seems to be a sensible and practical approach that could be considered for such cases in the future.

[jogs]

PassedOut, on 2017-July-05, 10:51, said:

Yes, the ACA needs to be fixed, but not by killing poor people.

The ACA is unfixable. The GOP plan will be no better.
Before the house wrote the GOP plan they voted 100% to exempt them and their staff from the plan.

10,000 Americans die everyday. Many of them are wealthy and younger than I.

2014 there was the VA scandal. In two years under Obama many died while on waiting list for care.
Obama has shown no ability to solve healthcare for millions of vets.
And the left thinks Obama has a clue how to solve healthcare for 325 million Americans.

[barmar]

jogs, on 2017-July-06, 08:42, said:

2014 there was the VA scandal. In two years under Obama many died while on waiting list for care.
Obama has shown no ability to solve healthcare for millions of vets.

Didn't he create a process for vets to go to private hospitals if they can't get into VA hospitals, and get reimbursed?

[Winstonm]

From Paul Waldman in WaPo:

Quote

If we were to institute some kind of single payer system, what we’d be doing when it comes to money is changing how we pay for health care. But when you say, “Hoo boy, it would mean trillions in new taxes!”, you’re acting as though we’d be paying all those taxes on top of what we’re already paying. But of course we wouldn’t.

Let’s look at what we’re paying now. In 2016, we spent $3.4 trillion on health care. That spending is projected to rise an average of 5.6 percent per year over the next decade. If you do the math, that means that between 2018 and 2027 we’ll spend $49 trillion on health care in America. That’s the current system.

That $32 trillion number the CNN folks are tossing around comes from an analysis of the Conyers bill, which is basically a placeholder — it’s only 30 pages long, which for bill texts is like an executive summary of an executive summary. If we get to single payer, the Conyers bill won’t be it. Nevertheless, Republicans have seized on the $32 trillion number to scare people into thinking that Democrats want to raise their taxes some insane amount (“When you look at the majority of House Democrats, they support a single-payer, $32 trillion bill backed by Bernie Sanders,” says Sean Spicer). But if we’re going to spend $49 trillion under the current system, and single payer would cost $32 trillion, doesn’t that mean we’d be saving $17 trillion? Congrats on all the money you’d be getting back!

Single payer may have faults - being too expensive is not one of them, though.

[cherdano]

The decision about Charlie Gard was not taken by bureaucrats, but by the medical team at his hospital. This decision was then affirmed by several courts. The view of the doctors and judges was that trying the suggested experimental treatment would be against Charlie Gards interests.

This case raises difficult questions that would be interesting to discuss. But that is hard to do while someone is spewing complete nonsense (bureaucrats???) about it, framing it as a fight between the free world and oppression under socialism.

[cherdano]

Zelandakh, on 2017-July-06, 06:35, said:

This seems to be a sensible and practical approach that could be considered for such cases in the future.

QALY played no role in the decisions about Charlie Gard. The decision against additional treatment wasn't made because treatment would be too expensive. It was made because, in the view of the medical team at GOSH, it would do more harm than good for Charlie Gard.

[jogs]

barmar, on 2017-July-06, 10:08, said:

Didn't he create a process for vets to go to private hospitals if they can't get into VA hospitals, and get reimbursed?

No, Trump did it in his 3rd month in office.

[cherdano]

PS: Should someone be genuinely interested in Charlie Gard's case, here is an interesting viewpoint.
http://www.independe...p-a7827276.html

[barmar]

Winstonm, on 2017-July-06, 12:30, said:

Single payer may have faults - being too expensive is not one of them, though.

Exactly. Taxes go up, but medical expenses go down, and these should generally cancel each other out.

Except that this is only really true if you look at averages, not individuals. Like most "revenue-neutral" changes to the tax codes, it shifts taxes and benefits from one group to another. And Republicans hate anything that raises taxes on the rich to provide more benefits to the poor.

But the other factor is that in a single-payer system, the payer has incredible leverage in negotiations, so the government should be able to control the prices, like they do under Medicare. If the prices for medical treatment go down, that's a benefit that applies across the board. It means the rich folks' taxes don't have to go up as much to provide the same benefits to the poor.

[ldrews]

barmar, on 2017-July-06, 14:49, said:

Exactly. Taxes go up, but medical expenses go down, and these should generally cancel each other out.

Except that this is only really true if you look at averages, not individuals. Like most "revenue-neutral" changes to the tax codes, it shifts taxes and benefits from one group to another. And Republicans hate anything that raises taxes on the rich to provide more benefits to the poor.

But the other factor is that in a single-payer system, the payer has incredible leverage in negotiations, so the government should be able to control the prices, like they do under Medicare. If the prices for medical treatment go down, that's a benefit that applies across the board. It means the rich folks' taxes don't have to go up as much to provide the same benefits to the poor.

It seems to me that the basic problem with single-payer, is that it is single-payer. With that concentration of spending power and money flowing through, I suspect there will be a lot bribery and regulatory capture taking place. Imagine how much money pharmaceutical companies would be able to offer the single-payer staff in order to get favorable treatment. And they would be able to spend enormous amounts of money developing ways to hide it. I can already imagine a Belizean Trust, funded by an offshore LLC, offering a fully paid tuition to the college of choice for the staffer's children.

[Zelandakh]

jogs, on 2017-July-06, 14:45, said:

No, Trump did it in his 3rd month in office.

So you are saying that the Choice Program was not introduced in 2014? What Trump did is sign up to a temporary extension of the plan. That is not to say that Trump's administration is not active though - here is a recent write-up of where things stand for the VA. Only time will tell whether the (probable) eventual privatisation ends up being a good or bad thing.

[barmar]

ldrews, on 2017-July-06, 19:36, said:

It seems to me that the basic problem with single-payer, is that it is single-payer. With that concentration of spending power and money flowing through, I suspect there will be a lot bribery and regulatory capture taking place. Imagine how much money pharmaceutical companies would be able to offer the single-payer staff in order to get favorable treatment. And they would be able to spend enormous amounts of money developing ways to hide it. I can already imagine a Belizean Trust, funded by an offshore LLC, offering a fully paid tuition to the college of choice for the staffer's children.

There are many countries with single-payer health coverage. Is this type of corruption a serious problem there?

The single payer is the government, and presumably the price controls would be set by legislation, not some low-level bureaucrats.

[jogs]

Zelandakh, on 2017-July-07, 02:35, said:

So you are saying that the Choice Program was not introduced in 2014? What Trump did is sign up to a temporary extension of the plan. That is not to say that Trump's administration is not active though - here is a recent write-up of where things stand for the VA. Only time will tell whether the (probable) eventual privatisation ends up being a good or bad thing.

Never heard of it. Only know vets were still dying on waiting during Obama's final two years. If this act were enforce and working, why did Trump need to fix it?
So when did this bill get signed into law by Obama?

[Winstonm]

jogs, on 2017-July-09, 05:44, said:

Never heard of it. Only know vets were still dying on waiting during Obama's final two years. If this act were enforce and working, why did Trump need to fix it?
So when did this bill get signed into law by Obama?

Have you considered looking at a more global aspect of problems rather than assigning blame based on partisanship? Here is a recap of VA troubles since 2000. The problems go back much further, though.

Quote

2000 -- The GAO finds "substantial problems" with the VA's handling of research trials involving human subjects.
2001 -- Despite a 1995 goal to reduce waiting times for primary care and specialty appointments to less than 30 days, the GAO finds that veterans still often wait more than two months for appointments.
2003 -- A commission appointed by President George W. Bush reports that as of January 2003, some 236,000 veterans had been waiting six months or more for initial or follow-up visits, "a clear indication," the commission said, "of lack of sufficient capacity or, at a minimum, a lack of adequate resources to provide the required care."
Walter Reed Army Medical Center was consolidated with another facility in 2005 and renamed Walter Reed National Medical Center.
Walter Reed Army Medical Center was consolidated with another facility in 2005 and renamed Walter Reed National Medical Center.
2005 -- An anonymous tip leads to revelations of "significant problems with the quality of care" for surgical patients at the VA's Salisbury, North Carolina, hospital, according to congressional testimony. One veteran who sought treatment for a toenail injury died of heart failure after doctors failed to take account of his enlarged heart, according to testimony.
2006 -- Sensitive records containing the names, Social Security numbers and birth dates of 26.5 million veterans are stolen from the home of a VA employee who did not have authority to take the materials. VA officials think the incident was a random burglary and not a targeted theft.
2007 -- Outrage erupts after documents released to CNN show some senior VA officials received bonuses of up to $33,000 despite a backlog of hundreds of thousands of benefits cases and an internal review that found numerous problems, some of them critical, at VA facilities across the nation.
2009 -- The VA discloses that than 10,000 veterans who underwent colonoscopies in Tennessee, Georgia and Florida were exposed to potential viral infections due to poorly disinfected equipment. Thirty-seven tested positive for two forms of hepatitis and six tested positive for HIV. VA Director Eric Shinseki initiates disciplinary actions and requires hospital directors to provide written verification of compliance with VA operating procedures. The head of the Miami VA hospital is removed as a result, the Miami Herald reports.
2011 -- Nine Ohio veterans test positive for hepatitis after routine dental work at a VA clinic in Dayton, Ohio. A dentist at the VA medical center there acknowledged not washing his hands or even changing gloves between patients for 18 years.
2011 -- An outbreak of Legionnaires' Disease begins at the VA hospital in Oakland, Pennsylvania, according to the Pittsburgh Tribune-Review. At least five veterans die of the disease over the next two years. In 2013, the newspaper discloses VA records showed evidence of widespread contamination of the facility dating back to 2007.
2012 -- The VA finds that the graves of at least 120 veterans in agency-run cemeteries are misidentified. The audit comes in the wake of a scandal at the Army's Arlington National Cemetery involving unmarked graves and incorrectly placed burials.
2013 -- The former director of Veteran Affairs facilities in Ohio, William Montague, is indicted on charges he took bribes and kickbacks to steer VA contracts to a company that does business with the agency nationwide.
Double amputee Bradley Walker goes through physical therapy to get used to a computerized prosthetic leg.
Double amputee Bradley Walker goes through physical therapy to get used to a computerized prosthetic leg.
January 2014 -- CNN reports that at least 19 veterans died at VA hospitals in 2010 and 2011 because of delays in diagnosis and treatment.
April 9 -- Lawmakers excoriate VA officials at a hearing. "This is an outrage! This is an American disaster!" says Rep. Jackie Walorski.
April 23 -- At least 40 veterans died while waiting for appointments to see a doctor at the Phoenix Veterans Affairs Health Care system, CNN reports. The patients were on a secret list designed to hide lengthy delays from VA officials in Washington, according to a recently retired VA doctor and several high-level sources.
April 28 -- President Barack Obama calls for an investigation into the situation in Phoenix.
April 30 -- Top officials at the Phoenix VA deny the existence of a secret appointment waiting list.
May 1 -- Shinseki places the director of the Phoenix VA and two aides on administrative leave pending the investigation into the veterans' deaths.
May 5 -- Veterans groups call for Shinseki's resignation. American Legion National Commander Daniel Dillinger says the deaths reported by CNN appear to be part of a "pattern of scandals that has infected the entire system."
May 6 -- Despite the clamor for Shinseki's ouster, White House spokesman Jay Carney says Obama "remains confident in Secretary Shinseki's ability to lead the department and take appropriate action." Shinseki tells the Wall Street Journal he will not resign.
May 8 -- The House Veterans Affairs Committee votes to subpoena Shinseki and others in relation to the Phoenix scandal.
May 9 -- The scheduling scandal widens as a Cheyenne, Wyoming, VA employee is placed on administrative leave after an email surfaces in which the employee discusses "gaming the system a bit" to manipulate waiting times. The suspension comes a day after a scheduling clerk in San Antonio admitted to "cooking the books" to shorten apparent waiting times. Three days later, two employees in Durham, North Carolina, are placed on leave over similar allegations.
May 15 -- Shinseki testifies before the Senate Veterans Affairs Committee. "Any allegation, any adverse incident like this makes me mad as hell," he says. At the same hearing, acting Inspector General Richard Griffin tells lawmakers that federal prosecutors are working with his office looking into allegations veterans died while waiting for appointments.
May 19 -- Three supervisors at the Gainesville, Florida, VA hospital are placed on paid leave after investigators find a list of patients requiring follow-up care kept on paper, not in the VA's computerized scheduling system.
May 20 -- The VA's Office of Inspector General says it is investigating 26 agency facilities for allegations of doctored waiting times.
May 21 -- Obama says he "will not stand" for misconduct at VA hospitals, but asks for time to allow the investigation to run its course. The same day, Shinseki rescinds Phoenix VA director Sharon Helman's $8,495 bonus. Helman got the bonus in April, even as agency investigators were looking into allegations at the facility.
May 22 -- The chairman of the House Veteran Affairs Committee says his group has received information "that will make what has already come out look like kindergarten stuff." He does not elaborate.
May 28 -- A preliminary report from the VA inspector general's office finds systemic problems at health facilities nationwide, and serious management and scheduling issues in Phoenix.
May 29 -- Political pressure mounts from Senate Democrats and others for Shinseki to go.
May 30 -- President Barack Obama accepts Eric Shinseki's resignation. Obama says he did so with regret, and said that Shinseki offered to step down at a White House meeting with the President so as not to be a distraction going forward. Obama said that Deputy VA Secretary Sloan Gibson will temporarily fill Shinseki's role as the search is launched for a permanent replacement.

[rmnka447]

Single payer sounds good in principle, but since something like 76% of healthcare in this country is delivered under employer supplied plans, the question is whether you can convince all those people covered under those plans that it's better to be covered by a single payer government plan. I suspect that will be a very tough sell with some severe political ramifications if jammed down people's throats.

[rmnka447]

Winstonm, on 2017-July-09, 12:40, said:

Have you considered looking at a more global aspect of problems rather than assigning blame based on partisanship? Here is a recap of VA troubles since 2000. The problems go back much further, though.

Nice summary through 2014, but here we are well into 3 years later and the problems still exist. Trump at least has signed into law a couple measures aimed at helping solve these problems. One let Vets see private doctors if the VA facilities couldn't provide timely healthcare. The other provided for dismissal of VA employees that weren't performing their jobs properly.

I'm sure opponents of single payer will hold up this system as an example of government run healthcare run amok. How do you protect people from ruthless or apathetic bureaucrats under single payer as much as you do ruthless or apathetic health insurance executives under the current system?