Death Panels? What Death Panels?

[dreadfulpenny81.livejournal.com]

During the heated debate last summer over the proposed health care legislation, Sarah Palin and Barack Obama kept bringing to the media the phrase 'death panels', groups of people that would decide whether or not to "pull the plug on Grandma". While Palin was misguided in her analysis (as she was trying to say that end-of-life care or the living will system was the 'death panel' when it actually wasn't), she may not have been entirely off-base.

Stories have been featured recently through several media outlets of patients in Arizona and Indiana who have been denied life-saving surgeries in the past several weeks and months due to cuts in state Medicaid budgets. In Indiana, a six-month old infant named Seth Petreikis has complete DiGeorge syndrome. A surgery that was deemed "experimental" by Medicaid was denied to him, but the company that manages Indiana's Medicaid program has offered to pay for the surgery themselves. [Source]

In Arizona, 98 people who were already approved for transplants were later told they couldn't receive the surgeries because of recent cuts to Arizona's Medicaid budget. One man was set to receive a new liver, which was donated to him by a friend who'd recently passed away. Because he couldn't pay for the $200,000 surgery, the liver went to another patient. [Source] The reason for this? On October 1, 2010, the state of Arizona removed transplants from a list of medical services that can be funded through the Arizona Health Care Cost Containment System (AHCCCS). Keith Olbermann is asking viewers of his show Countdown to donate in the hopes of funding the transplants. Meanwhile, Democrats in Arizona are now using the 'death panel' analogy as an attack against Gov. Jan Brewer and Arizona Republicans, who agreed to Medicaid cuts to balance their budget, despite protests from Democrats. [Source]

The 'death panels' Palin referred to have little to do with federal government action and more to do with state government blunders. There should be some legislation on the table to mandate organ transplant surgeries be paid for through all health care providers, public and private.Transplant boards are still necessary to sort through the amount of transplant candidates but at least someone who's promised a chance at renewed life wouldn't have to worry about that promise being taken away.

Comments

Re: No such things as a free organ transplant

[badlydrawnjeff.livejournal.com]

Of course you can go to another company. Not every company is going to have the same rules and restrictions. It's called a "benefit of choice."

Re: No such things as a free organ transplant

[badlydrawnjeff.livejournal.com]

I don't know of every insurance company out there. I do know that, if they accepted only people who were never sick, very few people would have health insurance, and most people do have it here.

Re: No such things as a free organ transplant

[telemann.livejournal.com]

Exactly.

Re: No such things as a free organ transplant

[badlydrawnjeff.livejournal.com]

Not at all. The cold hard facts are that most people have insurance here. If what you claimed was true, most people would not.

[lafinjack.livejournal.com]

I'm not sure it counts as having insurance for a lot of people if they're going to get dumped after they try to claim its benefits.

Re: No such things as a free organ transplant

[tcpip.livejournal.com]

I don't know of every insurance company out there.

That wasn't riotpredicted's request, it was "show me one who will".

Just one. You don't need to know all the insurance companies, just one which matches your claim.

Re: No such things as a free organ transplant

[badlydrawnjeff.livejournal.com]

I don't know of every insurance company policy out there, either.

Re: No such things as a free organ transplant

[moonchylde.livejournal.com]

And can't be bothered to look something up, because you might be proved wrong it appears. You can google stuff, yes?

Re: No such things as a free organ transplant

[telemann.livejournal.com]

Harvard School of Public Health / Henry Kaiser Family Foundation study demonstrated that one in 10 people with cancer said they could not obtain health coverage, (http://www.kff.org/kaiserpolls/upload/7591.pdf) and six percent said they lost their coverage, because of being diagnosed with the disease

Re: No such things as a free organ transplant

[telemann.livejournal.com]

That same foundation had a seminal report about this in 2002, and it really was horrible. Some of this is all moot now, as some elements of the Obama health reform laws have kicked in. Republicans may boast gleefully of undoing the law, but I'd love to see them try to get rid of this component :-D

Re: No such things as a free organ transplant

[badlydrawnjeff.livejournal.com]

That's actually a much better percentage than I would have expected, especially given the hysterics from those who hate our system so much. Kind of puts the concept that pre-existing conditions are the death knell of getting coverage to rest, eh?

Re: No such things as a free organ transplant

[moonchylde.livejournal.com]

Wait, you like those numbers? One in ten is not great odds for a losing proposition.

Re: No such things as a free organ transplant

[light-over-me.livejournal.com]

You see, insurance companies are all the same.

A common mistake, is in thinking that the current American health insurance system is completely privatized the way it is now, and then using that as an argument against private insurance/pro state run. It is not the case. Actually it is already highly government regulated and state controlled already, which is why you often find a small handful of big companies monopolizing a particular state/region. It has gotten so expensive that you pretty much need to purchase it through a group company rate, and it's very difficult to buy on your own as an individual. This isn't conductive to competition or choice, so the benefits thereof are pretty well mitigated. Which is why the privatization argument includes calls for deregulation and ability to purchase policies across state lines.

Also, you don't have to wait until you're severely ill to shop around for the best policy you can. You can look into how your chosen provider handles care for some of the most common diseases ahead of time. If cancer is the number 2 top killer in America, and you have a family history, you might not want a policy that screws you over when it comes to cancer screening.

Re: No such things as a free organ transplant

[politikitty.livejournal.com]

You do realize that in a free market, insurance doesn't work, right?

You have a hundred people with a bell curve amount of risk. Pooled together it's 10,000 dollars a year, so everybody is charged 100 dollars. The young healthy folk who realize their annual cost is very likely going to be under 100 dollars opt out.

Now you have sixty people pooling 8,000 dollars of risk. Insurance is now 133 dollars. Even MORE people drop out. So you've got fewer people pooling a higher ratio of risk. And it's a bell curve, so each subsequent price hike shaves an larger number of people off, requiring an even higher price hike.

There is no market equilibrium, and due to the shape of the demand curve, there cannot be a market equilibrium in insurance. Thus there is absolutely *NO* guarantee that a sick person hasn't been priced out of the market. That's exactly what an efficient insurance market will do.

Insurance works because it's mandatory. It was mandatory in the private markets because large companies provided the benefit to the entirety of their workforce.

Now that the labor market is far more fluid and you don't spend a lifetime in one company with one insurance company, that mandatory market has vanished.

We could just let the health insurance market die out. But that has a huge cost on both the government, free markets and public health. The externalities are far more staggering than that of optional car and home insurance (which are mandatory for this very reason). So I would think long and hard before advocating that option.

[allhatnocattle.livejournal.com]

bravo! Couldn't have explained it better myself. There's probably a daily quote in there somewhere.

Re: No such things as a free organ transplant

[gunslnger.livejournal.com]

You do realize that in a free market, insurance doesn't work, right?

Good. Insurance is gambling.

And your example isn't accurate. If it was, no one would buy lottery tickets. People would still buy insurance out of fear, and there would be enough buying to support the system. The only problem these days is that there isn't enough frightened people since the health of the population is generally pretty good.

So yes, if there is less demand for insurance, then that's a good thing. Insurance not being actual insurance is also part of the problem. People can't gauge the need for it accurately.

Re: No such things as a free organ transplant

[mylaptopisevil.livejournal.com]

i don't know if we should be advocating a fear-based system of marketing.

Re: No such things as a free organ transplant

[gunslnger.livejournal.com]

I'm not advocating it, I'm saying that's the only reason people buy insurance.

Re: No such things as a free organ transplant

[politikitty.livejournal.com]

First, pooling risk is actually the opposite of gambling. Forgoing insurance is gambling, though considering the asymmetric information and adverse selection issues with insurance, it's also perfectly rational gambling. Like, y'know, entrepreneurship and all market activity.

Maybe we didn't think through that example so well...

Lottery tickets do not have the overhead that health insurance requires.

If the market shrinks in lottery sales, the jackpot also shrinks. Supply costs can always change to handle fluctuations with demand.

You can't just decide to pay less for chemo. When your customer comes down with an expensive disease, you have to cover it. In an insurance market, as the market shrinks, the costs per customer increase. It will always be a rational and smart decision for the lowest risk customers to opt out.

You're hoping that most people aren't rational. (Which is usually a good argument for market interference, but hey) And while that can be true, we're seeing a lot of rational behavior in the insurance market. Kate Bundorf estimates that up to 3/4 of the uninsured can afford it and choose not to have it ().

That doesn't go into the question of how many people would not buy insurance if it wasn't subsidized by tax breaks and provided by most corporations. But I wouldn't hesitate the say that based on the tax break situation alone, we'd find that more people would voluntarily be uninsured if their company cancelled their policy.

Does that mean it's the rational and smart thing for society? No. We find that the uninsured have worse health outcomes (http://www.wsws.org/articles/2008/jan2008/heal-j05.shtml) than the insured population. Even if they brought it on themselves, it places an incredible burden on the health industry, the government and productivity as a whole.

A person who doesn't die from cancer contributes more to society than a person who does die from cancer.

It's possible that America is too healthy and we spend far too much money making people healthy when they have no intention on being more productive. A flat retirement age and the existence of medicare certainly suggests there might be some truth to that statement.

But considering the enormous externalities that exist (sick people transmit disease to healthy people, they don't go to work, they use emergency services more often, and have higher amounts of medical debt that raises the costs for everyone else, lower tax revenue from less hours worked, higher uncollectable debt, etc etc), we have some sort of collective incentive to keep the people around us healthy more than a perfectly free market would require.

Sure, there's charity. But that sorta creates free rider and principle agent problems. That's the problem with market failures. Sometimes they require government institutions to work.

Re: No such things as a free organ transplant

[gunslnger.livejournal.com]

The fundamental problem with your analysis is that "health insurance" in America is not insurance anymore.

Re: No such things as a free organ transplant

[politikitty.livejournal.com]

Oh dear. I didn't even realize that my attempt to find a non-gated publication led me to the World Socialist Web.

Here's a decent and more reputable link for uninsured health outcomes (http://www.mathematica-mpr.com/publications/PDFs/Health/Reformhealthcare_IB1.pdf).