Backstage - OOC Forums
General Discussion => The Speakeasy: OOG/Off-topic Discussion => Topic started by: Katrina Oniseki on 05 Oct 2013, 20:30
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Please note that a majority of this thread has become a political debate about private vs. national healthcare, unrelated to the intent of the OP. Relevant updates are linked below.
UPDATE 1 (http://backstage.eve-inspiracy.com/index.php?topic=5395.msg88018#msg88018)
UPDATE 2 (http://backstage.eve-inspiracy.com/index.php?topic=5395.msg88966#msg88966)
TL;DR
I might have a fractured rib, and I have no medical coverage. Wat do? (American & Low-Income)
So, let's start at the beginning..
Week 1: Around the beginning of September, I came down with flu-like symptoms. For the following week, a 102F degree fever was the norm, along with headaches, body aches, and general lethargy and mild nausea.
Week 2: Fever was fading away, but a cough had set in. It was a heavy rattling cough that did not 'produce'. Nausea and fever were mild, around 100F. Headaches were gone, body aches came and went with fevers.
Week 3: Fever is gone, cough is much worse. Coughing fits became the norm and were strong enough to cause dizzy spells and difficulty relaxing my muscles after. Near the end of Week 3, I had somehow caused a sprain or other injury in my abdomen. Coughing was producing phlegm, but not consistently or enough to stop the 'rattling' or 'itch' that fueled the fits.
Week 4: Coughing had not improved, but was finally producing consistently, relieving the whooping and wheezing spells. Since I was actually coughing phlegm up, the fits would be over immediately after and allow me some rest and recovery before the next urge to cough. Unfortunately, I had now developed sinus problems, which caused post nasal drip. During week four, I had several more exertion injuries during coughing fits that I assumed were sprained muscles. Two in the chest, one more in the abdomen, and one in my lower back.
Week 5 (now): We're now in the fifth week. The cough is finally dying down, my sinuses are clear, but one particular spot in my chest has not gotten any better. In fact, tonight, at work, it came back with a vengeance. It's located around the second from bottom rib on the right side. Pressing on the breastbone makes it hurt a little bit more, but not too much.
QUESTION: How serious is this for somebody who cannot afford to seek medical treatment? I can apply for local medical assistance (charitable free clinics that provide emergency care and medications to those who qualify for it), but that will take up to a month to get approved, and they are typically very overbooked. I'm not sure if the hospital in this area (Gaston County, North Carolina) is even on board with any low income assistance programs.
The real question I need to know is... should I just try to rest and let things heal up, or is this a medical emergency? What sorts of signs should I watch for that could be life threatening? It hurts badly, but so does a sprained ankle... and that's not life threatening. I don't even know if it's the rib. It could just be a muscle sprain.
Also... am I the only person who didn't know you can break a rib just by coughing?
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Update: My mother is a retired RN and has dropped off some sort of stretchy chest brace-compression thingy for me to wear, says it is what they made my grandpa wear when he broke a rib.
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It's hard to make a diagnosis on history alone, particularly history without the opportunity to cross-examine with relevant questions. Diagnosis is about 90% history and examination combined, with the remaining 10% made up of targetted investigations ... so take what I say with a grain of salt.
The first thing is the brace won't help you, not really. It depends on the brace, to some extent, but it goes something like this.
Pain due to fracture or muscle strain is usually best relieved with a combination of analgesia and immobilisation. The problem with the latter in the context of a rib fracture or muscle strain involving the chest is that you can't immobilise it - you stop breathing and you die, after all. Furthermore, limiting the mobility of your chest in order to decrease the pain (such as you do with a brace) typically exposes you to the risk of underinflating your lungs and the complications that arise from that (pneumonia, pleurisy, etc). So ... a soft/elastic brace might help somewhat while sleeping if pain's waking you in the night, but the mainstay of treatment is going to be regular simple analgesia (like paracetamol, or a combination of paracetamol/codeine) combined with a non-steroidal anti-inflammatory (ibuprofen, for example). The non-steroidal needs to be taken with food and water, following strict maximum daily dose guidelines and for every 3-4 days you use it regularly you should have 2-3 days off it to allow for some of the adverse effects it can have your renal and gastrointestinal system to subside.
So, the usual thing I prescribe:
1g paracetamol (+/- 16mg codeine) four times a day, orally
400mg ibuprofen three times a day, orally (following the rest day guidelines above, 3-4 days on out of every 7)
If you've got any sort of problem with stomach ulcers, gastrointestinal bleeding, severe reflux symptoms, etc or pre-existing problems with renal function avoid the non-steroidal (ibuprofen). If you've got a productive cough, fever, other signs or symptoms of an active chest infection avoid the codeine as it will suppress both your cough reflex and autonomic control of your breathing (to a minor extent) meaning you're unable to clear the infection from your chest as effectively which could make your condition worse or extend your time to recovery.
Obviously avoid extremes of exercise that exacerbate any pain you've got, but don't lie around in bed either - walking, light exercise, doing your usual activities, etc should not be avoided as long as they're not causing you undue pain. If you've got areas of point tenderness that you can find, maybe warm packs will help you there - you can make your own with wholegrain wheat/husks, some cloth and some thread to sew the cloth into a bag (there's probably better instructions online as I'm not a home and gardens type of person :) ).
I don't pretend to really understand the limitations of the US health care system and health insurance and things over there. If you were where I'm at I'd be getting a few blood tests done, a nasopharyngeal swab to exclude things like whooping cough (it doesn't sound like that so much as it sounds like a bad flu or maybe pneumonia that's now resolved/resolving) and a chest xray. The latter would be to make sure you don't have a collapsed or consolidated lung (either through puncture or persisting infection) rather than a fractured rib (which is sometimes difficult to see on an xray and doesn't really change the management anyway).
The last thing I would advise is that if you're a smoker, now's the time to stop. Either cold turkey or with nicotine supplements.
To sum up, while you might have a broken rib that would be unusual in otherwise healthy adults following a chest infection or upper respiratory tract infection. It's not unheard of, but the more common things for the persisting pain you're describing in one particular spot 5 weeks after what sounds like a fairly severe infection would be ongoing infection (ie, pneumonia) or a complication thereof (ie, pleurisy - inflammation of the chest wall lining, usually following infection). The treatment for a broken rib is symptomatic and aims to avoid the complications of under-treating the pain. The treatment for ongoing infection and complications of such is obviously more specific.
As I said at the outset, I can't examine you and I don't have a clear idea of your past history so that limits my usefulness and diagnostic accuracy.
If things aren't getting better, going to see someone who can examine you and order appropriate investigations is the best advice I can give.
Get well soon.
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So, while you are low income, it may not be a bad idea to call a local doctor/clinic and see what the cost is for you to go in and get a once over. Instead of worrying about whether you can afford it or not, ask them how much the visit is. Then if you choose to spend the money on the visit and get the basic stuff done, you can make the next decision about what to do based on the results of that visit.
I was uncovered for about 6 months and once I was covered the doctor berated me for not spending the ~$150 for a visit, ~$20 for some bloodwork, and ~$20 for my daily medication. And I was paying Los Angeles prices.
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Advice
That's good news to hear. I have been diagnosed with IBD, so I'll try not to take ibuprofen much. I didn't know it was bad for me. >_> I won't be able to get anything with codeine without a prescription, so that's off the table as well. I do have Tylenol, and have been taking below the maximum daily dosage for a while now, stopping every now and then as suggested.
For the most part, what you've suggested is what I've been doing, with the remaining stuff simply out of my reach right now.
I'm glad to hear it's probably not a rib fracture. It really does feel like a sprain, and it feels like it's on the outside. I will stop using the brace, since it seems like making sure I take full breaths is important here to prevent complications? That's also something I'm glad to hear, because it's so uncomfortable and makes me feel short of breath (which I guess I am, since I'm taking half breaths with it).
I don't smoke, by the way, so I ought to have some pretty clean lungs. :D
Anyways, thank you for your help. It's really relieving to hear that I probably don't need to run up a medical bill this month. Once again, you're awesome!
So, while you are low income, it may not be a bad idea to call a local doctor/clinic and see what the cost is for you to go in and get a once over. Instead of worrying about whether you can afford it or not, ask them how much the visit is. Then if you choose to spend the money on the visit and get the basic stuff done, you can make the next decision about what to do based on the results of that visit.
I was uncovered for about 6 months and once I was covered the doctor berated me for not spending the ~$150 for a visit, ~$20 for some bloodwork, and ~$20 for my daily medication. And I was paying Los Angeles prices.
Yeah. Until now I didn't have a need for a doctor in this county, so I'll need to look around and see who's available and at what prices. I figure they network a lot with each other, so someone ought to be able to point me in the right direction.
Doctor's tend to berate me a lot for not coming to see them earlier, so I can relate with that. :P
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No problems.
So, while you are low income, it may not be a bad idea to call a local doctor/clinic and see what the cost is for you to go in and get a once over.
Dex's advice there is excellent. Forewarned is forearmed, after all.
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Also, and I hate to do this but it's timely, anyone in the US reading this might want to reflect on one of our own NOT GOING TO SEEK NEEDED MEDICAL ATTENTION BECAUSE HE CANNOT AFFORD TO PAY CASH.
Just... You know... Keep it in mind the next time you're voting.
That is all.
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Not sure what you're getting at, Pieter.
What Kat's going through is extremely common in the US. He's probably just the only person in the RP community who will admit to it happening to him on a public forum.
I don't know too many details of his work situation, but I suspect Kat is either not being given enough hours to qualify for benefits at the place he works (often deliberate, and retardedly common at that - employers should be dragged into the street and shot for this practice), or his employer doesn't offer health benefits at all in the first place (also common, given the costs).
This is a fair bit of what the ACA is intended to help fix, so... uh, what?
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Get well soon!
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Not sure what you're getting at, Pieter.
I was kind of making the point that basic healthcare should be within the reach of all, not some sort of privilige
This is a fair bit of what the ACA is intended to help fix, so... uh, what?
So, one side of the two-party system in the US is fighting to dismantle an already flawed attempt to provide universal healthcare. I was asking people to bear this in mind, next election.
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Also, and I hate to do this but it's timely, anyone in the US reading this might want to reflect on one of our own NOT GOING TO SEEK NEEDED MEDICAL ATTENTION BECAUSE HE CANNOT AFFORD TO PAY CASH.
Just... You know... Keep it in mind the next time you're voting.
That is all.
I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. I prefer to keep my money in most situations. In this case, I actually find Kat's antics to be funny enough to willingly toss money their way, however, there are plenty of other people who I would prefer not to get medical care, especially at my expense.
Kat, if money is a problem, I can give you a hundred dollars. No strings. Paypal probably works.
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I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. [...]
Flipping that, the only people who profit off of people being unable to pay for healthcare are undertakers.
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I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. [...]
Flipping that, the only people who profit off of people being unable to pay for healthcare are undertakers.
I'm going to be paying more in taxes, fees, and insurance as part of the ACA. This makes me, a person who can already afford insurance, potentially worse off. The fact that others might benefit more than I am harmed does nothing for me, so don't bother with that excuse. Second, laws exist to help the people in power - if you think that the ACA will end up working out for the "little people", you are far more idealistic than I am.
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I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. I prefer to keep my money in most situations. In this case, I actually find Kat's antics to be funny enough to willingly toss money their way, however, there are plenty of other people who I would prefer not to get medical care, especially at my expense.
With all due respect, I don't think you understand what Taxes are for. Taxes aren't for things that benefit you as an individual, they are the 'cost' of the civilisation that benefits us all, indirectly. If you're feeling cerebral, go and do some research on the transition between hunter-gatherer tribes and more complex societies.
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With all due respect, I don't think you understand what Taxes are for. Taxes aren't for things that benefit you as an individual, they are the 'cost' of the civilisation that benefits us all, indirectly. If you're feeling cerebral, go and do some research on the transition between hunter-gatherer tribes and more complex societies.
I know exactly what taxes are for. I also know that much of the money extracted from me by my government neither serves my interests nor, as I see it, the interests of much of the population. I wouldn't have gone to war in Iraq for no gain. I wouldn't be paying for a defense budget of the size we have. I am not the one who is interested in an ever-expanding suite of regulations and fees. I wouldn't be funding a drug war that essentially serves to pay the wages of nosy cops and private prison companies.
Funnily enough, I am, however; and all of these things were sold to us on the basis that we needed them to protect some part of our civilization. Right. And, funnily enough, the ACA is also being sold to me on the basis that "people need it".
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Babies and bathwater. : /
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Babies and bathwater. : /
Maybe.
I'll note that, however, the problem here is that Kat needs the money now. Instead of feeling for him, perhaps someone should change something about the situation.
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Medical emergency. Where I live they would force you to at least see a doctor or to hospital right away :eek:
Seriously, I've had a whooping cough for the last year (yeah, that shit actually makes its comeback around vOv), that's not even a broken rib or something more serious, and when I eventually went to see a doctor because I started to wonder why a weird cough like that was not going away, she told me "what were you thinking ?" and then got to take extensive examinations and medical care.
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When I dislocated my shoulder as a kid, my parents waited a week, then brought me to a chiropractor who shoved it back in on the bench. When I somehow injured myself as a kid so that I was urinating blood, I just had to wait it out. When I broke my nose while swimming, I simply waited until it stopped bleeding, then went back to swimming. When I got bronchitis, I simply waited until it got better. Took about a year before major wheezing when I breathe out stopped, but I'm better. When I got a root canal, the painkiller failed to do anything (a common problem for me), but I had the dentist go ahead anyway.
The human body is tougher than it seems.
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Until the time when it will prove inevitably fatal to you, or lead to severe complications that will lead to hospital and maybe permanent injuries.
I'm more inclined to trust actual doctors than yourself on the matter. That would be rather reckless.
EDIT : to further add on the matter, I will be the last one to defend the "go see the doctor for every little shit" mentality we get here, which is quite the opposite of what I see of the US system. The social healthcare worked perfectly fine in the past I believe - and I still believe that it should be part of any modern society - but we tend to see the cracks now, with the crisis being a huge strain on budgets added to the fact that a lot of people go to see a doctor for absolutely everything, which further drains on social healthcare as a whole, with doctors sometimes behaving like commercials and prescribing more to please their patients. It may be less true these days because the social healthcare covers less things (especially generic medication that got literally cut off the healthcare), and even if it's supposed to be mandatory for every worker to have a complementary health insurance in part paid by the employer, some people still do not have one (I don't have one for example... >.>). In any case, the fact that it does not cover 100% (fortunately), makes that the people abusing the system are not poor people, but another kind of people. It's less true now ironically since because of :crisis: and :budget cuts: people abuse it less, or I believe so. But yeah, I don't like to see people go seeing a doctor every time they catch a cold.
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Nietzsche said "That which does not kill us will only make us stronger." the problem with that sentiment is that Nietzsche was insane and it was a load of old arse.
A lot of conditions, if ignored, disimprove. Ignore influenza, you can wind up with Pneumonia. Ignore a twisted ankle and it gets worse. Ignore rabies and you're dead. Kat's issue is a mechanical one - one of the ones I actually trust doctor's on. Treatment can only be a good thing - we're not talking about getting pills for feelings, here. Like it or not, our bodies were built to survive for about 35 to 40 years before wearing out. Anything that extends that warranty is good.
Incidentally, whilst your attitude towards solving the problem in front of us is very laudable, and will actually improve Kat's situation, your inability to be comfortable paying into programs you don't see direct benefit from or have direct control over is telling, given our earlier conversation.
Suffice it to say that the time when a government could work in that way is LOOOOOOOOOOOOOOONG gone.
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When I dislocated my shoulder as a kid, my parents waited a week, then brought me to a chiropractor who shoved it back in on the bench. When I somehow injured myself as a kid so that I was urinating blood, I just had to wait it out. When I broke my nose while swimming, I simply waited until it stopped bleeding, then went back to swimming. When I got bronchitis, I simply waited until it got better. Took about a year before major wheezing when I breathe out stopped, but I'm better. When I got a root canal, the painkiller failed to do anything (a common problem for me), but I had the dentist go ahead anyway.
The human body is tougher than it seems.
Ah, the famous American rugged individualism. I.e. Don't got cash? Suck it up and live with it. He said to someone with life-threatening disease or injury.
You know, every time minus the nose and dental problems, you we're basically rolling a medical dice in a game that is not that difficult to loose.
In real simple terms, you got lucky.
I don't think you can hold it against anyone for wanting their insurance to be something more than luck.
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I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs.
Well technically; if you do not live in complete solitude with the ability to cover all your needs yourself, you will inevitably benefit from your fellow citizens being healthy instead of sick. Regardless if that other person is a family member, co-worker or the supervisor at the power plant power that produces electricity for your computer to run.
No man is an island. Though sometimes we all wish we were.
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Wow. Well this became political overnight. I suppose my situation does serve as a good example.
To Vikarion; while I do appreciate the offer of support, I can probably manage to scrape together the money for a clinic visit myself if I can find one of the low in-come places like what was talked about earlier on in the thread. The problem is that while the visit itself might be $100, doing anything about the issue is not going to be that cheap. Doing anything but talking to a doctor is going to be expensive.
For example, $3,000 for an X-ray was the price quoted to me back in 2005, and we all know they're going to want to do one. $120 for two Tylenol pills (not a whole bottle). If they give me a chest brace, that costs more. If they vote for an MRI, that's even worse than the X-ray. All of that adds up very quickly during treatment, and it's a horrifyingly deep hole of debt to be in for something that may just turn out to be, "You probably sprained a muscle, just rest and make sure you take full breaths for a few weeks." As Ollie and others have said, even if it's a cracked rib, there isn't anything that can be done about it except treating the symptoms (pain), and reducing physical exertion there.
Now, on the other hand, I'm keeping a very close eye out for other symptoms. If I have trouble breathing, if there's any sign of bleeding, if I suddenly get a fever. If the pain suddenly becomes exponentially worse (total fracture). Any change in my condition toward the worse will be met with a thoughtless trip to the emergency room.
I don't want to stifle a political debate, because I think my situation is exactly the sort of thing that needs to be changed in America, but I should be okay I think. For those friends of mine who may worry ( :cube: Pieter), I WILL seek immediate medical attention if anything gets worse. That I can promise you.
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I'll not drag this further off topic by fueling the "let the lazy die/lets nurture everyone regardless" discussion.
Your mom is correct Kat. Ribs are usually left alone to heal on their own. You either get a brace/bandage/tape or nothing. Strenous activity is frowned upon of course. It's a bastard of an injury as laughter, tight hugs and coughing hurts like hell.
If the fracture is a bad one then it might be needing resetting though I can't see it coming from you coughing. You'd have to aggravate it on top of such an injury. If it's as bad as needing resetting then the risk would be you doing something that would make the brokwn rib puncture your lung.
That I'm not really seeing in this case.
Wear the brace, try not to cough or laugh and don't get into tight bear hugs that involve your lower chest.
This information and advice come from personal experience as well as basic medical training YMMV.
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What the... a MRI costs 250 € here...
Why is that so expensive in the US ? Are you sure you got the price right and it was not actually 300 $ ? :eek:
Anyway, as someone said above, just go see a doctor and see after if it's worth it or not imo.
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I'll not drag this further off topic by fueling the "let the lazy die/lets nurture everyone regardless" discussion.
Your mom is correct Kat. Ribs are usually left alone to heal on their own. You either get a brace/bandage/tape or nothing. Strenous activity is frowned upon of course. It's a bastard of an injury as laughter, tight hugs and coughing hurts like hell.
If the fracture is a bad one then it might be needing resetting though I can't see it coming from you coughing. You'd have to aggravate it on top of such an injury. If it's as bad as needing resetting then the risk would be you doing something that would make the brokwn rib puncture your lung.
That I'm not really seeing in this case.
Wear the brace, try not to cough or laugh and don't get into tight bear hugs that involve your lower chest.
This information and advice come from personal experience as well as basic medical training YMMV.
Yeah, that's the plan so far. I think it should work itself out. A fracture will mean I'll be sore for a couple months, and a sprain will stop hurting in a week or two. So, come two weeks, we'll know what it is.
What the... a MRI costs 250 € here...
Why is that so expensive in the US ? Are you sure you got the price right and it was not actually 300 $ ? :eek:
Anyway, as someone said above, just go see a doctor and see after if it's worth it or not imo.
No, I'm quite serious. The cost of a procedure is typically an order of magnitude higher than the technical and labor cost of it. An X-ray should only be $50, but it's much much much higher because of... reasons. I don't really know what the reasons are, but it has something to do with insurance and subsidies.
http://www.newchoicehealth.com/MRI-Cost
http://www.newchoicehealth.com/X-Ray-Cost
Here are some updated prices. I aimed a bit too high for the X-ray, but I'm glad to see the price could be lower. Granted, it could be higher too.
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What the... a MRI costs 250 € here...
Why is that so expensive in the US ? Are you sure you got the price right and it was not actually 300 $ ? :eek:
Anyway, as someone said above, just go see a doctor and see after if it's worth it or not imo.
Nope, the US has ridiculously high costs on standard non-invasive medical procedures.
I had a comparison, but I lost it.
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:ugh:
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An English comedienne does a bit about having gone over to America to work, and while she was there severely spraining her ankle. She had to spend a night in hospital.
That single night in a bed cost her $2000.
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Time Magazine earlier this year had an excellent article, something like 37 pages?, on the US healthcare system and exactly why it is the way it is. It's too long to go into here, but basically, US laws involving free trade are abused by wealthy private interests and as these interests are large-scale funders of Washington, attempts to fix the laws fall flat on the House and Senate floors.
Welp.
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For a less flamebaity response,
It would actually be cheaper for you guys in the states would be paying LESS taxes for your healthcare AND not going backrupt every time you broke your leg if your heathcare industry was not profit focused. Like every other civilized country in the world.
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Can we get a thread split to discuss the problems of the US Health Care System and the challenges in reforming it?
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Nope, the US has ridiculously high costs on standard non-invasive medical procedures.
I had a comparison, but I lost it.
If you have insurance, the hospitals make a huge mark-up, and the insurance companies say "yeah, we''re not paying that much" and negotiate it down to something reasonable. If you don't have insurance, the hospitals take you for everything they can.
On the other hand, they have to take you in in an emergency.
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When I dislocated my shoulder as a kid, my parents waited a week, then brought me to a chiropractor who shoved it back in on the bench. When I somehow injured myself as a kid so that I was urinating blood, I just had to wait it out. When I broke my nose while swimming, I simply waited until it stopped bleeding, then went back to swimming. When I got bronchitis, I simply waited until it got better. Took about a year before major wheezing when I breathe out stopped, but I'm better. When I got a root canal, the painkiller failed to do anything (a common problem for me), but I had the dentist go ahead anyway.
The human body is tougher than it seems.
Ah, the famous American rugged individualism. I.e. Don't got cash? Suck it up and live with it. He said to someone with life-threatening disease or injury.
You know, every time minus the nose and dental problems, you we're basically rolling a medical dice in a game that is not that difficult to loose.
In real simple terms, you got lucky.
We're all going to die someday. But, actually, I was sort of commenting on Lyn Farel's post, to wit, that you don't have to immediately run to the emergency room at every sniffle. Which Lyn agreed with.
And, yes, I think that there's some major potential for abuse with American attitudes for health care. It may surprise you, but in some areas, at least, Americans tend to treat their insurance as essentially a free ticket to everything from acupuncture to elective plastic surgery, which some states mandate insurance companies must cover.
In America, health insurance companies tend to have a profit margin in the low single digits, unlike some other companies. Since businesses seek the most profitable business model, this suggests that any additional attempt to provide health care to the American people is going to result in a net rise in premiums.
I'm not actually opposed to the ACA...yet. I certainly don't care for Republican policies either. I just tend to think that schemes by the well meaning tend to result, all too often, in rather nasty outcomes. Consider the effect that the political drive to get lower-class people into houses had. Theoretically laudable goal, bad execution.
The problem isn't that people don't have health care, or that they don't have a house, it is that they don't have enough money.
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Wow. Well this became political overnight. I suppose my situation does serve as a good example.
To Vikarion; while I do appreciate the offer of support, I can probably manage to scrape together the money for a clinic visit myself if I can find one of the low in-come places like what was talked about earlier on in the thread. The problem is that while the visit itself might be $100, doing anything about the issue is not going to be that cheap. Doing anything but talking to a doctor is going to be expensive.
For example, $3,000 for an X-ray was the price quoted to me back in 2005, and we all know they're going to want to do one. $120 for two Tylenol pills (not a whole bottle). If they give me a chest brace, that costs more. If they vote for an MRI, that's even worse than the X-ray. All of that adds up very quickly during treatment, and it's a horrifyingly deep hole of debt to be in for something that may just turn out to be, "You probably sprained a muscle, just rest and make sure you take full breaths for a few weeks." As Ollie and others have said, even if it's a cracked rib, there isn't anything that can be done about it except treating the symptoms (pain), and reducing physical exertion there.
You might be surprised. Ask the docs if there's any way you can get an x-ray for cheap. Also, as far as pain meds go, they're relatively less expensive if you get them from a pharmacy. After my wisdom teeth were removed (surgery I paid for out of pocket), I was able to get Norco (essentially codeine pills, but stronger than normal) from a pharmacy at probably $1-2 a pill. Not bad, considering they lasted for eight hours (well, for most people - my body tends to ignore them pretty quickly). If pain is a problem, something like Norco can make life much easier.
And the offer remains open.
P.S. What large city do you live near? Might be able to find a few places.
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Despite my desire to see a thread split, here are some videos about the US Health Care.
Why Are American Health Care Costs So High? (http://youtu.be/qSjGouBmo0M)
Bigger Pizzas: A Capitalist Case for Health Care Reform (http://youtu.be/R7LF5Vj2n64)
To put it another way, stop attempting to appeal to some people's humanity and appeal to their greed.
If the American Health Care system was radically reformed (made socialist) the broader US economy could improve as companies large and small could start to focus resources (money) that they currently spend on employee health care on other things. All without raising taxes.
Warning: it likely will result in the collapse of the medical insurance industry.
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Find someone with the stethoscope who can listen to make sure it isn't walking pneumonia. I assume mom could, if she had a stethoscope.
Otherwise idk. I fight with companies trying to get 'the rest' of their money all the time. I let the bills sit. i already pay 300 for medicare and medicare supplement insurance.
Even with insurance I go only when 1000% necessary for stuff, cause in my situation every year they assume an angelic host came and healed me, and so I need do have Dr's fill out paperwork that says, "Nope, she's still as fucked as she was, if not worse." ;)
Yay 'murica.
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(http://www.labspaces.net/pictures/blog/4e5466b7dc69f1314154167_blog.jpg)
Back from work today, with good news!
The pain is significantly better already, which means (thankfully) that it's probably just a sprain. If I had a fractured rib, I imagine I'd still be in quite a lot of pain. The whole fractured rib thing was really the result of my employer mentioning it. The conversation went something like this:
"Well I probably sprained it. It's not like you can break a rib by coughing, lol"
"Yes you can."
"I can?!"
"If you have a fractured rib, you need to fill out a work incident report and go to the hospital..."
"Well hold on, how do I know I broke a rib?"
"You don't, which is why we're going to fill out this report and send you to--"
"Wait a minute, if we fill this out, I can't come back to work until a doctor clears it as healed right?"
"Correct."
"Which for an uninsured person, if I can't find a doctor to do that, I lose my job."
"..... correct."
"No thanks. I did not break a rib picking up a rotisserie chicken."
"Are you sure? You have 24 hours to file if you change your mind tomorrow."
"I'm sure for now. I'll let you know tomorrow morning."
So, I needed to ask some questions about how serious a broken rib is, if I needed to risk my job filing a report and seeking worker's compensation to get treated, and basically where to go. Come morning, my chest was feeling a lot better (admittedly under the influence of some leftover pain meds from a while back). After working the shift, with my chest still feeling much improved long after the meds wore off, I'm fairly convinced that it was a sprain.
Which means I made the right call by not filing the report. If I was still feeling terrible and in great pain, I would have had to make that difficult decision to risk my job on it, but I'm glad I don't have to.
Since my medical issue is mostly resolved, I think we can let this thread continue as a political discussion if people are so inclined.
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Glad to see you are doing better, Kat <3
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That's...cool. :)
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As someone whos broken more than a few ribs in his day, I can pretty much tell you what the doctor would have said to you.
"Well, that sucks dude, heres some pain meds." Unless you've like, punctured your lung or something, theres not much to do. Sometimes a brace or bandage to isolate torso movement, but even that is of limited effectiveness.
Just be happy you didnt fracture your sternum, that heals, like, never. Between a fullback's helmet and another dude's elbow two days later, it got busted up, and it never really healed. I can still feel it going low on a pushup or something. Cartilage doesnt like to regrow.
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I'm glad you're doing better, Kat. I still say that when people can't get basic medical care (including PREVENTATIVE MEDICINE) then society as a whole suffers.
Frankly, I don't care WHICH system gets used provided it delivers that endcase.
Also, I am not speaking from the bench either. Former rugby player and some time in the Army means that I have wrecked ankles, knees, shoulders, wrists and all the small bones in one hand. Plus numerous concussions - all of which I had checked out. Soft tissue injuries can be every bit as bad as a broken bone. Take 'em seriously.
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Hooray! Glad its not a ball of pneumonias.
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Thanks everybody, for all the support. :)
« Last Edit: Today at 05:48 PM by Vikarion »
Thank you for the compliment. :cube: ;)
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As someone who had a mystery health issue that very nearly cost me $300 for no help (its a long story), I'm glad it seems to be resolving on its own.
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Thanks everybody, for all the support. :)
« Last Edit: Today at 05:48 PM by Vikarion »
:P Editted because I suddenly suspected it might be taken the wrong way somehow. Glad it wasn't. :P
Thank you for the compliment. :cube: ;)
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Good to hear you are doing better Kat <3
Meanwhile in Socialist Canada, I passed out at work because I am a dumbass and lifted things I shouldn't resulting in the start of a hernia. Got a ultrasound and hooked up to some heart thingy (my brain sucks I cant remember what its called), took some blood, and some other yummy bodily fluids. Sat around for 4 hours, and got to go home without a bill. I do love our slow free healthcare system sometimes.
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So, I needed to ask some questions about how serious a broken rib is, if I needed to risk my job filing a report and seeking worker's compensation to get treated, and basically where to go. Come morning, my chest was feeling a lot better (admittedly under the influence of some leftover pain meds from a while back). After working the shift, with my chest still feeling much improved long after the meds wore off, I'm fairly convinced that it was a sprain.
I once had five broken rips and my sternum was fractured. (A car accident). It was very painful, but the doctors told me that the broken rips will heal themselves. It took quite a while and I was on heavy pain killers for a month or so. My biggest problem at this time was that my lungs were full of blood and my spleen was in danger of rupturing—luckily it didn't. All that I wasn't allowed to do was to work over head. But I am a human scientist, not a doctor, so I can't really help.
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I hope things continue to improve swiftly.
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Things are unsure at best right now. I still have crackling and wheezing when I breathe, suggesting fluid in my lungs and/or collapsed alveolar. Right now, no other symptoms have appeared, and I'm watching myself closely to determine if I need to run to the ER. I'm currently doing searches for local clinics and trying to work out a way to get seen by one.
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I missed this.
I am very happy you're ok Kat! Get better soon! Mystery chest pain can be the scariest stuff, especially as we get a bit older... is it an embolysm? A clot? What is it?? I am happy you have a mom who can help, and the folks here gave awesome advice and offers of help too! If youre having fluid in your lungs, GO TO AN ER PLEASE? Dont wait, just go. They have to see you. A lot of charities will help pay after such ER visits.
Just as an FYI, for anyone interested, I had a knee surgery a while ago (Torn ACL and meniscus in my right knee) and could not even walk without crutches or help. I had no healthcare.
It took me nearly 8 months (January to August) to get a charity to agree to help me with the bills. No one would see me until I could prove I could pay. The US Healthcare system does not care if you cannot walk. When I did go get my surgery, the charity paid it - except the 1,800 dollars for my leg brace, which I had to pay.
The surgery itself was 31,000 dollars.
The "recovery room" i stayed in was 11,000 dollars. I was in here for about 2 hours ( I was asleep, I dont remember exactly )
The MRI was nearly 7000 dollars.
All told, the surgery was nearly 60k, for a 3 hour outpatient procedure. How, exactly, is anyone who isnt very well off supposed to pay this themselves? And it is not like this is of benefit to society - I could not walk, and therefore, could have gotten disability benefits.
It is sad. And the health program didnt fix it and got all gutted =(
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Kat, just keep in mind, the times I broke my ribs, I knew it. Like, would almost black out from pain if someone bumped into me kinda knew it. Hopefully was just a sprain.
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I found a health clinic with a sliding pay scale (all the way down to free). They also have dental! I'm going to walk in monday. I've already downloaded the sign-up paperwork, so I'll have it filled out when I get there. :D
Hopefully I'll see a case worker and get myself an appointment soon.
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I found a health clinic with a sliding pay scale (all the way down to free). They also have dental! I'm going to walk in monday. I've already downloaded the sign-up paperwork, so I'll have it filled out when I get there. :D
Hopefully I'll see a case worker and get myself an appointment soon.
\0/ Huzzah!
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As an Englishman, the horror stories of American healthcare make me extremely nervous about our Conservative government's work to privatise our national healthcare. I like the NHS as it is :|
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As an Englishman, the horror stories of American healthcare make me extremely nervous about our Conservative government's work to privatise our national healthcare. I like the NHS as it is :|
Don't let them.
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As an Englishman, the horror stories of American healthcare make me extremely nervous about our Conservative government's work to privatise our national healthcare. I like the NHS as it is :|
Don't let them.
I would argue as with most things there is a balance that can be achieved and may be necessary.
For example, in a entirely tax-funded system (cost is hidden from patient), if someone refuses to get a flu vaccine each year (which is free), then contracts the flu and puts a strain on the medical system (and larger society) to care for them, how is the behavior discouraged? Is it fair to force everyone to have the vaccine? What about other preventative care?
What about the person who does not make good dietary or health choices, does not have an annual physical, and then is rushed to the hospital when their body final collapses and they are diagnosed with Type 2 Diabetes? Once they are stable, is it society's burden to pay for the individual's choices?
At the same time, when parents are making the right choices for their child, including annual checkups, and they rush to the hospital when the child is attempting to expel acid through their lungs due to Type 1 Diabetes, the last thing I want those parents to worry about is "can I pay for this?" The same goes for the person working their job and having their hand crushed or leg broken. These are generally not the result of a pattern of poor choices by the individual.
I am very much in favor of a tax-funded health care system, especially for true emergency and child healthcare. I, however, struggle with a totally free health care system for adults where the choices of the individual burden society as a whole. Part of it is an attempt to balance individual liberty, including the freedom to make stupid decisions, with providing good health care. I suppose the real problem is that I am in the middle and am trying to seek a balanced solution.
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The last time I checked, making unwise health choices was not subject to the death penalty. Remember? The point of a societally funded health care system was that it avoids making us have to step over dead people in the street.
It would be better to spend money on finding a solution for the issue, like a smarter pancreas, than to deny healthcare in the hopes that the affected die off without causing too much of an eyesore.
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The last time I checked, making unwise health choices was not subject to the death penalty. Remember? The point of a societally funded health care system was that it avoids making us have to step over dead people in the street.
It would be better to spend money on finding a solution for the issue, like a smarter pancreas, than to deny healthcare in the hopes that the affected die off without causing too much of an eyesore.
That is what you think the purpose of a health care system is? So we don't step over dead people in the street?
I thought it was to keep people healthy and able to contribute to society. And there in actually lies my issue, you know that first paragraph of questions I asked.
For example, in a entirely tax-funded system (cost is hidden from patient), if someone refuses to get a flu vaccine each year (which is free), then contracts the flu and puts a strain on the medical system (and larger society) to care for them, how is the behavior discouraged? Is it fair to force everyone to have the vaccine? What about other preventative care?
I ask these questions not out of hyperbole. I ask them because I honestly struggle with them myself.
Is it right for our (current) society* to force on its inhabitants health care they do not want? (Even if they may very well need it.)
There are clear societal benefits from ensuring that everyone has an annual check-ups, is appropriately vaccinated, preventive/early treatments, etc.
At what point does society overstep?
*I often contemplate what many would consider sci-fi societies, like early Martian or free-space colonies.
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To me it seems perfectly normal to force people to get that damn vaccine. Same for smokers, just banish those damn cigarettes. And deny the access to healthcare to morons that still continue to use them through contraband, but I know all of that ain't happening any time soon.... Just forbidden in public places. :bash:
To practice sport and eat properly to avoid obesity, diabete and cholesterol is a bit trickier of course, and that's a good question. I guess it's a strain that has to be expected, but it doesn't prevent the state to ideally encourage people to do so. Maybe they could finance more sport stuff in companies as they already do in schools where it's part of some classes, don't know...
That's a very american thing to focus so much on individual liberties. We don't care much here. Quite a different mindset. But tbh nothing of this is forced, everybody have the choice, even for vaccines. You are not forced to go see a doctor regularly, even for your children... And that can be a strain.
On another note, the social healthcare here is funded through taxes yes, but most of it is not actually paid by individuals. Most of its funding comes from taxes on salaries (on the companies side even more than the employee's side), taxes on alcohol, taxes on car insurances, etc. So eventually it costs more when you buy from those services, but it's not included in a tax everyone pays everytime. But well, the social healthcare has become a gigantic monster (covers health, retirement, family allowance, and a lot of other things) in debt due to laxist policies and bad management over years (contrary to the german one which has too much money...).
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The last time I checked, making unwise health choices was not subject to the death penalty. Remember? The point of a societally funded health care system was that it avoids making us have to step over dead people in the street.
It would be better to spend money on finding a solution for the issue, like a smarter pancreas, than to deny healthcare in the hopes that the affected die off without causing too much of an eyesore.
Suppose some people are just determined to be obese. Let's say that they live for eating. They want nothing else out of life but to eat. They balloon up as far as they can go, and suffer the attendant health problems.
Or suppose someone smokes, and refuses to stop. Suppose someone is determined to drink, to the point of committing crimes to get at alcohol. Or suppose that...and so on and so forth.
On the other hand, I'm not obese, I'm not a smoker, I'm not an alcoholic, and I don't play with flammable substances for shits and giggles. Objectively, I am far less likely to inflict costs on the health system. Yet, you seem to think that I should be responsible for paying for the care of those who make choices that create an undue burden on others.
Why should I be responsible for the bad behavior of others? And why should behavior that is self-destructive be, essentially, subsidized? It's not like we are running out of people, and the fact of your existence does not grant you the right to make demands that others support your life.
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What may look like a choice, is not always a choice. The amount of support people get from the surrounding community, in the form of family, friends and work, varies wildly. You can't just simply make these factors to be the way you want them to be but they contribute a lot to how likely it is that you develop an addiction or some other problem.
Also, addictions are not rational decisions, it wouldn't make any sense and our brain doesn't work that way. It's just silly to try to apply the rational consumer theory to them. You can argue that in the beginning some degree of choice is involved but because not everyone who smokes or drinks casually develops an addiction, that can't be the entire truth about it.
I hope you get better soon, Katrina.
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As an Englishman, the horror stories of American healthcare make me extremely nervous about our Conservative government's work to privatise our national healthcare. I like the NHS as it is :|
Don't let them.
I would argue as with most things there is a balance that can be achieved and may be necessary.
I very much agree with this, although not with the implications of the questions that follow it. There is a balance and it can be achieved, although it is a fine balance and its impacted on by numerous external and internal pressures.
To answer your hypotheticals from the view of someone who lives and works as a health professional within an entirely tax-funded health care system:
For example, in a entirely tax-funded system (cost is hidden from patient), if someone refuses to get a flu vaccine each year (which is free), then contracts the flu and puts a strain on the medical system (and larger society) to care for them, how is the behavior discouraged? Is it fair to force everyone to have the vaccine? What about other preventative care?
It's not discouraged, that's coming at it from the wrong angle. Individuals have a strong drive to ignore most negatively-framed advice that might be given to them. The key to achieving success in a public health campaign is to educate on, emphasize and encourage the positive outcomes of good preventative health strategies rather than discourage ignoring them. My apologies for the double negative, but successful outcomes in this area are very much about perception.
Flu vaccines don't offer 100% protection against all forms of influenza. They do offer some benefit in indices of time to recovery and time to return to work (ie, indices of morbidity/cost to health system and productivity) but only significantly in high-risk populations. Therefore in the system I have around me, the influenza vaccine is only offered free of charge to health care workers, diabetics, those at extremes of age, those with pre-existing health conditions that would worsen significantly under the effects of influenza (heart failure, lung/airway disease, cystic fibrosis and so on). There are a few other groups that get the benefit of free flu vaccine also.
Those patients outside these groups wishing to obtain a seasonal flu vaccine are able to do so at their own cost, which is usually subsidised by the government under what's called a Pharmaceuticals Benefits Scheme - the same scheme our government uses to make most medicines affordable to those needing them.
There are no mandatory vaccines in our health system although that is something currently being considered by various state governments to address lowered levels of herd immunity that studies have shown to be developing over the last decade.
What about the person who does not make good dietary or health choices, does not have an annual physical, and then is rushed to the hospital when their body final collapses and they are diagnosed with Type 2 Diabetes? Once they are stable, is it society's burden to pay for the individual's choices?
Our society's view is that - as a developed first-world nation of reasonable affluence and social comfort - it is the role of our society and its government to provide support for its people across a variety of fronts. Support in health care is one of these fronts. In doing so we aim to effect the return of individuals to health and productivity as rapidly as possible without the need to enter into high levels of personal debt or forego basics of healthcare in the process. In those cases where a return to full or functional pre-morbid levels of productivity isn't possible we have other welfare networks in place to support them as well. Nothing occurs in a vacuum, ideally.
We seem to get by with this view. We have a good quality of life (a generalisation of course), a satisfactory level of infrastructure and an education system that ranks quite highly among similarly developed nations. We have good systems of 'free' (ie, user does not pay) health care and social support. We have welfare systems which public pressure forces continued review of. We have a 3-year election cycle at local, state and federal levels to ensure that if due diligence is not undertaken we can at least get rid of those responsible in favour of those who may be able to.
That said, two of the key obstacles to such a system are size of the population (larger populations obviously become exponentially harder to support in such a manner) stacked against GDP and national/international debt levels. What works for us with a population that approaches only 30 million will not necessarily work in some African, SE Asian, South American or North American nations without significant support from medical charities or NGOs and is almost certainly never going to be a viable option for nations like India and China each of whose populations exceed 1 billion people.
At the same time, when parents are making the right choices for their child, including annual checkups, and they rush to the hospital when the child is attempting to expel acid through their lungs due to Type 1 Diabetes, the last thing I want those parents to worry about is "can I pay for this?" The same goes for the person working their job and having their hand crushed or leg broken. These are generally not the result of a pattern of poor choices by the individual.
The point of a taxpayer-funded health system isn't to lay blame or pass judgement on who gets treatment and who doesn't. It's among the first tenets of the Hippocratic Oath, which - although it's fallen out of favour in the years since the Greek gods you swore it to faded from popular worship - is still a pretty good ethical document for physicians to bear in mind. Disease, in general, doesn't discriminate and while it can be argued that patterns of poor health choices inevitably result in some sort of adverse outcome related to them in my experience it's not that black-and-white in actual practise.
The morbidly obese smoker with diabetes and severe heart disease doesn't choose to be crushed in a multiple vehicle high speed motor accident, for instance, but his or her other comorbidities are going to have a serious health and dollar impact on their treatment and - if they survive - their recovery.
Those of us working inside these health systems understand this on multiple levels. I figure I've seen and treated in excess of 30 to 40 thousand individuals in the course of my career. I have empathy for all of them, even as I silently curse and rail against many of them for ignoring health advice that could have prevented or lessened their problems and saved the government's health bill anywhere from few hundred to thousands on thousands of dollars.
The problem for a health worker in that specific situation is you're there to deal with the issues that are facing you at that point in time. There's no point in wasting 10 minutes berating a 70-year old struggling for breath because of his emphysema about the smoking habit of 150+ pack years (3 packets a day for 50+ years) that brought him to your doorstep.
A) It's not going to help him breath any better.
B) He probably started smoking before he even knew exactly how bad it was for him.
Afterwards, you offer him nicotine replacement and tell him to quit smoking or he doesn't get the home O2 he desperately needs (because those are the barriers the government puts on that treatment), you tell him to get a regular chest x-ray (and network with his GP or arrange it yourself to make sure it's followed up on) because of his risk of lung cancer and you put what social supports he needs in place. But you still do whatever you can for him in all those respects.
Likewise with the obese, Type II diabetic whose leg is gangrenous and is rapidly entering septic shock with its attendant sequelae of multiple organ failure and death. What he needs immediately is stat antibiotics, a saline drip, a knife to release any abscess followed quickly by a high-risk general or spinal anaesthetic and a probable amputation. You can worry about the diabetic education, advice on weight loss and lifestyle changes, the problems he'll have achieving mobility and any level of pre-morbid independent function along with a full medical screen for other complications of diabetes if he survives and recovers from that.
In those situations, we don't get to sit in philosophically constructed ivory towers and decide who's worthy of treatment and who's not. And from my point of view as a health professional, we also shouldn't be adding up in some part of our heads how much we or our hospital/health institution stand to make off the poor rube for trying to stop him dying a bad, early death. To me, that's grossly unethical and one of the many things I cannot understand about systems that don't provide some measure of tax-funded support.
Nor is it enough for us to just treat the problems as they arrive. Health care professionals and administrators working in a taxpayer funded system are also responsible for two areas which grease the wheels of said system:
1) It's incumbent on us to be involved with preventative medicine and public health strategies either in actively promoting them, accessing them and following up on our patient's utilisation of them or in researching and developing them, making them cost-effective and then selling them to the government for approval. It's not enough to be just a good doctor, nurse or allied health/social work professional in this type of system - you have to have vision and be able to innovate as well.
2) We have to be gatekeepers - we have to recognise that for every investigation/therapy we order and get approved for one patient there's another patient who's potentially going without or being forced to wait for that same investigation/therapy. Resources are finite. To my way of thinking this makes us, in general, far more efficient and better at our jobs. We don't order a slew of ineffectual investigations with a scattergun approach - we survey, determine the possibles and try to work through that list by process of elimination and careful choice of relevant investigations.
There's one further thing to add, in the context of the specific tax-funded health care system I'm part of.
We still have private health care. It doesn't really cost much, and it provides a great deal for those who can access it.
We encourage people to adopt private health care cover to decrease the utilization (and therefore cost/strain of resources) of the public health system for a number of reasons. These include access to surgeon/physician of your choice (rather than the on-call doctor of the day or even a physician/surgeon in specialist training), shorter waiting lists for routine non-life threatening procedures and treatments, local access to certain forms of treatment (radiation theraphy and chemotherapy for cancer where a patient might have to travel 800km+ to access the same treatments at public health facilities, as an example) and tax deductions/benefits that (in some cases) cover the cost of the health insurance itself.
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You know, society bears each other's burdens in more ways than one. Just by going about your day you can and do add to and take the strain from the burden. Absolutely no-one is purely just adding or taking the strain.
Which is why it's puzzling to me that folk complain so much at one of the best ways to make sure the strain of society's burden is lessened, i.e. ensuring your society is healthy. It's a universal plus, when last I looked.
It's called the social contract, and even America loves it. They just seem happy in the closet.
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What may look like a choice, is not always a choice. The amount of support people get from the surrounding community, in the form of family, friends and work, varies wildly. You can't just simply make these factors to be the way you want them to be but they contribute a lot to how likely it is that you develop an addiction or some other problem
Well, unless you don't believe in choice, you still have to deal with moral hazard.
Ok, let's say it's not a choice. So what? Let's say that we have a quadriplegic who can't provide for himself, and who also is suffering from a disease that will be terminal unless we spend one million dollars/euros on him. Why should we save this person?
If you are supporting this person, you aren't bearing each other's burdens. You're bearing his, and he isn't bearing anyone else's. This is essentially parasitism, where one party gains at the cost of others. Why does it matter whether it was a choice? It's still there. And how far are you willing to go with this? What if it's not 1 million, but two? Or ten? Or a hundred? Or a billion?
If you (rhetorical "you") really believe that life is so sacred that it is worth any material costs, then you should sell all of your luxuries, supply yourself with the basic necessities to live and work, and donate all excess to those who are in danger of dying, in whatever form will best sustain them. On what grounds do you argue that we should all be forced to do this, but not you in particular, who advocates it? The resources of society are finite, too.
Or if you do want to place a limit, what better spot than at the point of sustainability, the point at which the cost of treating someone is less than their further contribution to society? Of course, our current system in the U.S. does far less than this.
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What may look like a choice, is not always a choice. The amount of support people get from the surrounding community, in the form of family, friends and work, varies wildly. You can't just simply make these factors to be the way you want them to be but they contribute a lot to how likely it is that you develop an addiction or some other problem
Well, unless you don't believe in choice, you still have to deal with moral hazard.
Ok, let's say it's not a choice. So what? Let's say that we have a quadriplegic who can't provide for himself, and who also is suffering from a disease that will be terminal unless we spend one million dollars/euros on him. Why should we save this person?
If you are supporting this person, you aren't bearing each other's burdens. You're bearing his, and he isn't bearing anyone else's. This is essentially parasitism, where one party gains at the cost of others. Why does it matter whether it was a choice? It's still there. And how far are you willing to go with this? What if it's not 1 million, but two? Or ten? Or a hundred? Or a billion?
If you (rhetorical "you") really believe that life is so sacred that it is worth any material costs, then you should sell all of your luxuries, supply yourself with the basic necessities to live and work, and donate all excess to those who are in danger of dying, in whatever form will best sustain them. On what grounds do you argue that we should all be forced to do this, but not you in particular, who advocates it? The resources of society are finite, too.
Or if you do want to place a limit, what better spot than at the point of sustainability, the point at which the cost of treating someone is less than their further contribution to society? Of course, our current system in the U.S. does far less than this.
Well since we're talking about millions and supposedly ridiculous uses for money - I can think of plenty of examples where $1,000,000, two, ten, a hundred, or a billion dollars have been spent on far stupider, far less helpful, and far more costly things. Tax dollars. Like, paying for the President's family vacations to Africa. Or, paying for my governor to have an affair in Brazil. Or paying for three or four failed attempts to replace the M16. Or paying for the entire Iraq, Afghanistan, and possible future Syrian war. Or how about my parents paying for Vietnam and Korea? What about paying for the countless other sorry attempts at things I don't agree with or don't see any benefit from?
After paying for all of that, am I supposed to feel okay with the logic that it's somehow wrong or stupid to save a stranger who has an otherwise terminal illness? Am I supposed to feel stupid for paying those taxes, after paying for wars and frivolity?
I'm sorry, but I can't agree with your logic. You say it's not worth paying millions to save a man from death. I say it's not worth it to pay The President's salary and vacations.
Guess which one is mandated by law?
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It is very easy to say that until you experience it yourself.
Don't agree ? Well, it has yet to happen to you, has it ?
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Can'st thou, who commands the beggar's knee, also commandst the health of it?
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Ok, let's say it's not a choice. So what? Let's say that we have a quadriplegic who can't provide for himself, and who also is suffering from a disease that will be terminal unless we spend one million dollars/euros on him. Why should we save this person?
A population of 300 million people supporting a single person's 1 million dollar hospital bill comes out at a total cost $0.003 per person. :roll:
The reality is that the numbers in your hypothetical are arbitrary. This illustrates a hole in your reasoning - you've got no real idea of the costs incurred or the ways in which those working within a tax-payer funded system are able to manage that cost.
In the scenario you're talking about it's not the role of 'society' in general to make the decision on who gets their treatment or not - a tax-payer funded system has already decided that should the health professionals responsible for the person's care decide there is benefit in treating him the money is there to do so.
I can point from my own experience to multiple examples of the exact scenario you're describing. I've treated people with burns > 60% surface area where we decided it was best to do nothing and let them die rather than spending the ~50 million dollars it would have taken to give them even the slimmest chance of survival and been the one to communicate that to their next of kin and convince them it was the right decision for all involved. I've told cancer sufferers (on nearly a daily basis since I started working) that they're terminal and that no treatment was going to cure them and they most I could give the was time with some quality of life - and did they want it? I've made decisions on who to take off life support and who to keep on it in critical care situations. All of these decisions are based on a dual understanding of risk vs. benefit (for the patient) and outcome vs. cost (for the system), typically in that order of priority. The surprising thing is that far from being 'parasitic' most people are reasonable in these matters once they've had their questions answered and concerns explained.
It's the responsibility of the health system and its workers to make the decision to treat (or not) and then explain to the patient and their family why they believe their decision is the best course of action. In the system I work in, by and large, we manage that decision responsibly with respect to both the requirements of the patient/family and the resource limitations placed on us.
You seem to understand this in the last sentence of the quoted post, but the rest of your commentary seems to be based on needless scare-mongering and misinformation.
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Well since we're talking about millions and supposedly ridiculous uses for money - I can think of plenty of examples where $1,000,000, two, ten, a hundred, or a billion dollars have been spent on far stupider, far less helpful, and far more costly things. Tax dollars. Like, paying for the President's family vacations to Africa. Or, paying for my governor to have an affair in Brazil. Or paying for three or four failed attempts to replace the M16. Or paying for the entire Iraq, Afghanistan, and possible future Syrian war. Or how about my parents paying for Vietnam and Korea? What about paying for the countless other sorry attempts at things I don't agree with or don't see any benefit from?
After paying for all of that, am I supposed to feel okay with the logic that it's somehow wrong or stupid to save a stranger who has an otherwise terminal illness? Am I supposed to feel stupid for paying those taxes, after paying for wars and frivolity?
I'm sorry, but I can't agree with your logic. You say it's not worth paying millions to save a man from death. I say it's not worth it to pay The President's salary and vacations.
Guess which one is mandated by law?
This is a logical fallacy: that because X has happened, I must support Y, even though X is something that has no causal relationship with Y. I don't support X, either. If you want, you can go back and look at the Syria thread, where I was entirely opposed to those sorts of expenditures as well. The fact that those things have been done has no bearing on what should be done except in terms of practicality.
But my question remains: how much are you going to argue we should spend on those who are sick? The argument seems to be that human life is more important than economic considerations, including moral hazard. So how much would you impoverish everyone to save every last life? Or do you, like I, think that one must have a cut-off at some point?
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Ok, let's say it's not a choice. So what? Let's say that we have a quadriplegic who can't provide for himself, and who also is suffering from a disease that will be terminal unless we spend one million dollars/euros on him. Why should we save this person?
A population of 300 million people supporting a single person's 1 million dollar hospital bill comes out at a total cost $0.003 per person. :roll:
I picked numbers out of the air because I wanted to start relatively small. My question is, aside from sentiment, what is there to be gained in sustaining someone who contributes less to the rest of us than they consume?
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As I said, I believe that your question was irrelevant at best and scare-mongering at worst.
In the tax-payer funded system you're talking about that question isn't the responsibility of society to answer but that of trained health professionals who keep their eyes on both the costs involved as well as what benefit treatment will or won't offer to their patients. It's a decision that's made at every branching point of treatment for every patient on an individual basis.
Addit:
To answer the specific hypothetical you addressed, in the tax-payer funded system I work within we would explain to the patient that his/her disease is terminal and what we should be aiming to achieve with any treatment is adequate quality of life with whatever time he/she has remaining. Aggressive 'curative' treatment would not be put on the table as an option because it offers no benefit and comes at significant risk and cost. Treatment would be palliative with an intent to minimise the symptoms that bother him/her. Euthanasia would not be offered - it goes against the principal of what a doctor is there to do and it is also illegal in our country. Withdrawal of all treatment - which usually results in speeding up the demise of a terminal patient - would be offered if the patient or family (if the patient is incapable of making the decision) agreed to it.
That's how the system you're describing in your hypothetical actually works in practise, at least in my experience.
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But my question remains: how much are you going to argue we should spend on those who are sick? The argument seems to be that human life is more important than economic considerations, including moral hazard. So how much would you impoverish everyone to save every last life? Or do you, like I, think that one must have a cut-off at some point?
You're right, you did say you were opposed to the war spending. I'll grant you that.
I just refuse to accept the concept that treating someone's health is less important than going to war. I realize that isn't what you meant, but that is what's happening. We spend on much worse things than healthcare, and I do feel it's very deeply wrong.
I would prefer a system where there are limitations on what can be paid for using taxpayer money, yes. I'm not willing or qualified to state what those limits would be. I'm just a poor kid in the back woods. I don't know enough to judge.
That said: I'm sorry, Vik. I just can't agree with you that healthcare financing should be remain almost completely privatized in the U.S. It's my political opinion, and I have and will continue to vote on it.
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It's not like this is completely intellectual as an exercise. Look at almost completely privatised healthcare (America) and various degrees of nationalised healthcare (the rest of the civilised world) and ask yourself which one is achieving the objective of providing the best averaged standard of health for the most efficient cost.
The problem with a privatised healthcare system is that it's objective is making money, not providing healthcare. That's why the US healthcare system is SO inefficient.
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I will counter with the DoD's Healthcare System and the VA Healthcare System.
Neither of which are interested in making money, combined both are serving a population well over 20 million people. If you want to see how the US Federal Government would run a nationalized healthcare system, look at the systems they are running.
That is not to say that I don't think the people of the United States can not pursue universal healthcare. I just have little to no faith that the USG can execute a worthwhile centralized system ran from Washington DC. Los Angeles county (~10M people)? Maybe Vermont (626k people)? Sure.
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That is both amusing and sad at the same time, assuming I understood you correctly.
Unless I'm mistaken, you just advocated we not try, because the United States of America is too inept to do it correctly? Not only that, but you backed it with evidence.
That is shameful. That is utterly shameful.
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That is both amusing and sad at the same time, assuming I understood you correctly.
Unless I'm mistaken, you just advocated we not try, because the United States of America is too inept to do it correctly? Not only that, but you backed it with evidence.
That is shameful. That is utterly shameful.
I advocated that the we should not attempt to establish a health care system for 330+ million people ran by the Federal Government of the United States, based upon how said Federal Government executes the health care system it operates for veterans who have served it.
I did however say that I think we can and should pursue universal health care, but that we should work to enact it on smaller scales than 330+ million people. I think a health care system designed for North Caroline needs to be inherently different from one designed for Oregon or Iowa. The system for New York City is different than Los Angeles and incredibly different for the Dakotas, Wyoming, and Montana.
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That is both amusing and sad at the same time, assuming I understood you correctly.
Unless I'm mistaken, you just advocated we not try, because the United States of America is too inept to do it correctly? Not only that, but you backed it with evidence.
That is shameful. That is utterly shameful.
I advocated that the we should not attempt to establish a health care system for 330+ million people ran by the Federal Government of the United States, based upon how said Federal Government executes the health care system it operates for veterans who have served it.
I did however say that I think we can and should pursue universal health care, but that we should work to enact it on smaller scales than 330+ million people. I think a health care system designed for North Caroline needs to be inherently different from one designed for Oregon or Iowa. The system for New York City is different than Los Angeles and incredibly different for the Dakotas, Wyoming, and Montana.
Hmm. Alright, that is much more palatable.
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It's not like this is completely intellectual as an exercise. Look at almost completely privatised healthcare (America) and various degrees of nationalised healthcare (the rest of the civilised world) and ask yourself which one is achieving the objective of providing the best averaged standard of health for the most efficient cost.
The problem with a privatised healthcare system is that it's objective is making money, not providing healthcare. That's why the US healthcare system is SO inefficient.
It really is that simple. I find it very difficult to question the idea that they are NOT in it for anything BUT profit. From that alone, healthcare should be a public utility (you know...like fire and police?) and not a private money-maker.
I wager that Vikarion's belief system and those who follow it will die out as this generation continues, anyway.
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I wager that Vikarion's belief system and those who follow it will die out as this generation continues, anyway.
One can only hope. His attitude - and the number of people who share it, in all its infuriatingly unhealthy (hurr) levels of backwardness and blind stupidity - is sickening, and one of the reasons I fucking hate the situation in this country, and the people who put it that way.
I had a longer rant about how stupid and ignorant that attitude is, but frankly, not worth it.
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That said: I'm sorry, Vik. I just can't agree with you that healthcare financing should be remain almost completely privatized in the U.S. It's my political opinion, and I have and will continue to vote on it.
I'm not actually for a specifically privatized health care system. I'm generally of the opinion that most of the options we have right now are all bad. What I want to see is a system that provides care for reasonable causes (accident, injury, sickness) without providing care that essentially subsidizes the useless or stupid at a cost to everyone else.
For example, I'd like you to be treated, and I'd also like it if an obese smoker who refused to quit was required to pay much of his own way, or die if he can't. Those who eat and act in healthy ways should be rewarded for their efforts, not required to support those who do not.
Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.
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Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.
I don't think we need you in it either.
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You were doing just fine until you ended your post by advocating eugenics.
In which case, you probably don't need Inflammatory Bowel Disease either (which is hereditary), so I shall go find myself a quiet little inexpensive grave. :cube:
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I wager that Vikarion's belief system and those who follow it will die out as this generation continues, anyway.
One can only hope. His attitude - and the number of people who share it, in all its infuriatingly unhealthy (hurr) levels of backwardness and blind stupidity - is sickening, and one of the reasons I fucking hate the situation in this country, and the people who put it that way.
I had a longer rant about how stupid and ignorant that attitude is, but frankly, not worth it.
Those who are capable of operating on a cold analysis of cost/benefit will always have an advantage over those who do not.
That said, as I've mentioned before, I don't think that a completely private system is the most efficient administration of health care in this country. I also don't think that the United States will be best served by a completely public system.
My biggest concern is that it be an efficient and innovative system. The system in the United States is fairly innovative, possibly the most innovative, but it sure as hell is not efficient. That is to say, it is not providing good care for the majority of the citizenry.
But to simply assert that the United States would magically become awesome at health by adopting a NHS is to fail to realize that some of the worst problems are a result of diet and activity. Americans eat way too much bad food, quite honestly. It's not just what sort, but how much. And they engage in quite a lot of other bad activities. A health care system that does not dis-incentivize and punish bad behavior is going to result in major problems, as undue resources are devoted to those who pursue risky and dangerous behaviors.
Nor is it wise, financially, to devote extensive amounts of resources to those who will never have the potential to repay them. This may be unpalatable, but efficiency really does rule over all. If resources are not directed efficiently, there will be no system to treat anyone with.
To wit, and the question I was trying to pose, what do you do with the curable, but otherwise terminal, patient who will cost a million to fix? What about ten million, etc? This isn't a concrete question, it's a hypothetical, and it's essentially asking how much you think preserving a life is worth, in resources. If you say, all of them, then you rob all the other people who need help. Otherwise, you are going to have to decide where you cut people off, or refuse to treat even otherwise save-able people. Right now, that occurs in the U.S. privately - you don't have enough money, you die. This seems horrible, apparently, to people who aren't me. Fine. But no matter what, there are going to be people who you could save, but can't afford to. How are you going to select those people?
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Bah. Not everything is genetics - and half of the genetics you're decrying were PRO-survival genes when refined food was less available. And we have bigger problems. Our current interpretation of ethics doesn't have us exposing the handicapped at birth.
Moreover you are WRONG about a costs/benefits analysis. Civilisations are founded by those whose passion and faith allow them to dig a little deeper.
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You were doing just fine until you ended your post by advocating eugenics.
In which case, you probably don't need Inflammatory Bowel Disease either (which is hereditary), so I shall go find myself a quiet little inexpensive grave. :cube:
I rather doubt that IBD costs more to treat than you put into the economy. So nice try, but you have to live.
I'm somewhat optimistic: I think that genetic treatments will soon exist which may give us a way out. But what about those people who don't want to stop being addicted to nicotine, or those people who don't mind being obese? Trust me, I've met them, they're out there.
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Moreover you are WRONG about a costs/benefits analysis. Civilisations are founded by those whose passion and faith allow them to dig a little deeper.
Civilizations, almost to a one, have typically been founded by those who had no problems killing their fellow men and taking their stuff. What happened to Native Americans? How about the Neanderthals? Where are the peoples that opposed the Assyrians? Where is Carthage? This sort of action is less passion, and more selfishness. I understand that.
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Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.
I don't think we need you in it either.
From a standpoint of efficiency and reason, I eat well, I don't smoke, I contribute a lot to the economy, I pay my taxes, and I rarely impose costs on others. Kill me, and you'll be poorer, on the net. :P
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Moreover you are WRONG about a costs/benefits analysis. Civilisations are founded by those whose passion and faith allow them to dig a little deeper.
Civilizations, almost to a one, have typically been founded by those who had no problems killing their fellow men and taking their stuff. What happened to Native Americans? How about the Neanderthals? Where are the peoples that opposed the Assyrians? Where is Carthage? This sort of action is less passion, and more selfishness. I understand that.
Where are the Assyrians? And the Romans? Alexander consumed Darius, but he choked on the meal. Napoleon conquered 85% of Europe, but his Empire lasted less than a lifetime.
Don't get me wrong, I don't subscribe to the 'I came. I saw. I felt really bad about it afterwards." school of thought, either.
But here's the thing. Successful civilisations are ones who divide the world into inliers and outliers and then are ruthless towards the outliers while NOT being a bag of dicks to each other. If one Anglo-saxon in a village was starving, odds are that nobody had very much food...
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Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.
I don't think we need you in it either.
From a standpoint of efficiency and reason, I eat well, I don't smoke, I contribute a lot to the economy, I pay my taxes, and I rarely impose costs on others. Kill me, and you'll be poorer, on the net. :P
Cost isn't always measured in currency. You're pathetic.
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I'll point out here that there are many people who work but lack healthcare. The continued characterization of those without healthcare as economic parasites is unnecessary.
I'll also give a personal example: My mother has worked all her life, and while employed, she was diagnosed with breast cancer. After surgery, she had to do radiation and chemo therapy, which meant she was too ill to work fulltime, but still came in on a part-time basis.
So her boss fired her and she immediately lost her health benefits. We ended up having to pay for the rest of her treatment out of pocket.
Decades of working and paying taxes mean nothing when it comes to health care. All that matters is that you're employed at the moment.
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Decades of working and paying taxes mean nothing when it comes to health care. All that matters is that you're employed at the moment.
And even then, being employed often means nothing when your employer is unwilling to give you the hours to qualify for (or afford) health care.
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Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.
Right.
I'm going to skip explaining how eugenics is biologically unsound and just point out that 'obesity, smoking addiction, and chronic illness' usually kill you long after childbearing years. 80% of people with lung cancer are 60 or older. Heart disease rarely effects anyone under the age of 45.
Dying does not remove you from the gene pool. Not having children is what does it.
While I'm at it, if you wanted to remove those "genes" from society, you'd need to kill a lot of healthy people who don't smoke, aren't overweight, and aren't suffering from any terminal illnesses. For example, while diabetes only expresses itself in 8% of the population, 98% of Europeans carry one of the genes that causes it.
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Decades of working and paying taxes mean nothing when it comes to health care. All that matters is that you're employed at the moment.
And even then, being employed often means nothing when your employer is unwilling to give you the hours to qualify for (or afford) health care.
Retired people are not covered if I understand correctly ?
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They can be through what we call Medicare. Medicaid is supposed to help low/no-income people/families with healthcare. People often get the two confused.
The problem Makkal is speaking about is that many people in the US are covered through their employers - but this coverage is dependent on having that job. Lose the job, lose the benefits.
I'm referring to the common practice by employers to only give workers just under the hours where they are required, by law, to provide benefits to those employees. So if the threshold is 30 hours a week, they'll give you 29.5 hours a week and force you not to work any more than that so that they can avoid giving you benefits.
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You know, the NHS and others like it aren't just a drive-thru heal-ya-up.
In their countries, they also tend to be the biggest health advocacy groups, responsible for programmes which improve general health across the board.
So, Vikarion, they'd actually be saving you money, by prevention. Not just treatment.
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Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.
I don't think we need you in it either.
(http://www.reactiongifs.com/wp-content/uploads/2013/02/impressed.gif)
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There are times when I really wish I could 'like' a post here on Backstage, because this whole page is full of em.
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There are times when I really wish I could 'like' a post here on Backstage, because this whole page is full of em.
Your avatar really ruins the serious atmosphere of any thread, you know.
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I think that this is an emotion-laden issue, or, at least, I'm guessing it is. I don't find it to be so. Nonetheless, after talking with a friend today, I think I've not been entirely clear on what I mean by some of these things. I'm going to try to rephrase.
First, let me clarify what I'm not in favor of. I'm not in favor of simply letting people die because they don't have enough money. Were it up to me, people like Kat would get treatment. An efficient use of resources is to distribute them where they do the most good. When the private market accomplishes this (as in most goods) the private market is best. However, there are areas where services and some goods are best allocated using other models, such as government.
Second, let me clarify what I'm worried about. What I'm worried about is the perception that moving to a different model will solve for resource scarcity. That is to say, there are only so many resources to go around. It is quite alright to agree that the current distribution is, to say the least, not the best. Yet, even if resources are redistributed, there will only be so many to distribute. And even if we tax people more to pay for them, at some point there will arise a reluctance on the part of the taxed to do any more work. Or, to put it another way, people aren't willing to give all of their discretionary income to health care.
Thus, as economists recognize, we are left with the problem of distributing scarce (as in, not unlimited) health care resources. We don't have enough doctors, drugs, and machines to take care of everyone as much as everyone would like to be cared for. It would be nice if this were not so. But it is, and it will remain so for the foreseeable future.
Now, many seem to be angry that our current U.S. system largely distributes health care on the basis of ability to pay. That is to say, the more money you have, the better you will be cared for. I agree that this is not a recipe for good things. But it does not follow that because we move to a system which does not utilize financial capability as a sorting machine, therefore we will no longer have shortages. We will.
Consider Britain's NHS. The National Health Service is an interesting model. Some prefer it, some prefer a simple single-payer system, and some, such as myself, think that Obamacare is probably worth exploring on a practical level. The NHS largely avoids the problem of people dying for lack of treatment, but the large waiting lists for electives seems to imply that this is not without cost. In other words, there are only so many beds and doctors, and only so many hours in a day. As well, there have been questions over rationing and denial of services to some people:
http://www.telegraph.co.uk/health/healthnews/9706918/50000-denied-treatment-to-save-NHS-cash-claims-Labour.html (http://www.telegraph.co.uk/health/healthnews/9706918/50000-denied-treatment-to-save-NHS-cash-claims-Labour.html)
http://www.theguardian.com/society/2012/apr/28/doctors-treatment-denial-smokers-obese (http://www.theguardian.com/society/2012/apr/28/doctors-treatment-denial-smokers-obese)
http://www.theguardian.com/society/2011/apr/18/nhs-cost-cutting-surgeon-warning (http://www.theguardian.com/society/2011/apr/18/nhs-cost-cutting-surgeon-warning)
Who, in this thread, was noting that we might need to deny some people treatment? Ah, yes. It was me. Apparently that makes me a horrible person. That's fine, but it also appears that I may also be a correct horrible person.
Given limited resources, there are tough questions to be asked. One I gave my debating friend, for example, was the following: suppose you have a thirty-year-old meth addict, a total burden to society, who needs drugs and an operation to save his life (a life-saving operation). On the other hand, for the same cost, you have three forty-year-olds who could be provided with the hip replacement surgery (an elective) which they need to keep their jobs and not live a pain-filled life.
My friend, who has an emotional attachment to the "sanctity of human life" (this is a phrase that makes me laugh - try that on a hungry tiger or vicious disease) chose the meth addict. I chose the three forty-year-olds. This is what I mean when I say that we don't necessarily need genes for addiction in the gene pool - a statement I made when someone argued that addictions were not choices. It doesn't mean that I think we need to weed people out - that is inefficient and stupid, and I have the sneaking suspicion that moralists would consider it wrong. ;) What I mean is that I don't see those who indulge such things as more important than the functional and useful members who also need treatment. Or, to put it in another way, we don't need those people as much as we need other people - people like Dex, and Kat, and, frankly, myself, who are functional, working members of society. In a "fairness" sense, from the example above, why should you be required to pay, by giving up an elective that you need, for someone else's bad choices? Why should they get to take an out-sized portion of resources?
This is cost/benefit. I'm sorry that you don't like it, but it rules this world, because this is a world that exists on the knife edge of entropy. It doesn't really matter if the addict chose to be addicted or not. What matters is that switching to a different system of distributing health care is not going to solve the problem of there being scarce resources - and arguing that we should switch to a different system because it will solve for scarcity is to lie to oneself and others. A better distribution, it may be.
Now, Pieter has said that, last he checked, making unwise health decisions is not a death penalty. It seems that the sentiment that we should save people from their bad behavior is popular. Well, I disagree, at least, somewhat. Jumping off a bridge, for example, is a decision with drastic health ramifications. As is smoking. As is reaching into a running garbage disposal. In fact, most of the things we consider to be fairly stupid decisions are such because of their potential for...immediate and drastic health ramifications. And yet, the person who smokes is embracing a repeated and informed pattern of self-destructive behavior, while the farmer who dies as a result of forgetting to turn off the wood-chipper machine before maintaining it is guilty of a momentary lapse of judgment. Yet, who here would cry about how unfair it is that the wood-chipper did what a wood chipper does? Probably no one. That's just life - the result of making a bad decision. But to suggest that the person who embraces an entire lifestyle of health-destroying behavior might well be held responsible for it...that is apparently monstrous. I make no other claim than that, if I have to choose between treating the cancer-ridden smoker and the non-smoker, I'm of the opinion that the latter is a more efficient use of resources.
As well, we must be watchful for the "tragedy of the commons" situation. This is a problem that occurs when costs for behavior are a burden to an entire community, rather than just an individual. For example, suppose that I have to pay for my own car. In that case, I am likely to take care of it, because I am invested in it. On the other hand, suppose my community maintains a fleet of cars. In that case, I'm less likely to take care of it, because I bear no significant cost if it is damaged. Now, rationally, this may not be true - if everyone acts like that, soon we will be out our fleet of cars. Nonetheless, that is how humans tend to act, and this has bearing on health care. If you have to pay for treatment yourself, you are more likely to take care of yourself than if others have to pay for your treatment. How much of a problem you see this as probably depends on your view of human nature. I take a somewhat dim view, personally.
And I'm not willing to give up too much of what I value to ensure health care for everyone, and I'd bet that you aren't, either. For example, if you could cure one child of cancer by eliminating Eve Online from your life, permanently, and devoting the subscription costs to that child's care, would you do it? What if you could save ten children by never buying or playing a game again, and using that money? Would you do that? What if you could save a hundred children by devoting all money you did not physically need to their care? (Peter Singer wrote an essay about this, here: http://people.brandeis.edu/~teuber/singermag1.html (http://people.brandeis.edu/~teuber/singermag1.html) .) Would you do that? Because, if you would, you could do that now - in fact, you could save many more than one child with the fees you pay to Eve Online. But I have the suspicion that you aren't willing to do that. Therefore, I doubt that you would be willing to pay enough into a system for everyone to get as much healthcare as they need. And I'm using children as an example and a real thing, here - how much less would you be willing to pay for every drug abuser, smoker, and drunk?
TL;DR: There is no TLDR. Except this: there is no free lunch, and changing things does not necessarily fix them.
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The problem with reducing people to an analysis of how much they consume versus how much they contribute is this.
Economic systems are supposed to be there to support people. People are not supposed to be spending all their effort in supporting a particular economic system. If the system isn't working well for most people then it is broken and needs to be repaired or replaced.
As for your earlier example of someone who is very disabled and needs a lot of care; what can they contribute? Ever hear of a man named Stephen Hawking (http://en.wikipedia.org/wiki/Stephen_Hawking)? Granted, by the time Hawking started to deteriorate he was already studying his doctorate. But if you reduce a person to simplistic economic terms you are likely to miss a good part of what they can offer.
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Economic systems are supposed to be there to support people. People are not supposed to be spending all their effort in supporting a particular economic system. If the system isn't working well for most people then it is broken and needs to be repaired or replaced.
As for your earlier example of someone who is very disabled and needs a lot of care; what can they contribute? Ever hear of a man named Stephen Hawking (http://en.wikipedia.org/wiki/Stephen_Hawking)? Granted, by the time Hawking started to deteriorate he was already studying his doctorate. But if you reduce a person to simplistic economic terms you are likely to miss a good part of what they can offer.
Not to be offensive, but that's a rather simplistic view of what an economy is. What economists have come to realize is that economic systems are essentially organic, and not limited solely to humans. The idea that you can just "decide" to have a different economic system is essentially a fairy tale, from a modern economist's point of view. There is a very good reason why every successful nation in the world today is capitalist, from Sweden and Norway to Japan and South Korea.
The constraints and impositions we place on a capitalist economy are not, on the other hand, necessarily bad things. They are things we want, driven by the incredible economic power of human trading and production in a capitalist economy. But there is only so much burden you can place on a capitalist economy - it is not an endless fount of bounty to be reaped. As for socialism and communism, they are dead in terms of scientific viability, and have been for some time. Keynes and Friedman have won that argument.
It is interesting to note that the economic expenditure on government services of a country like Germany (43.7 percent) is not all that different from, say, the United States (38.9 percent). How the money is spent, of course, is a different matter.
As for Stephen Hawking, I tend to believe that those who have managed to get Ph.Ds in physics are more useful than, say, meth-heads. But hey, let's say that a cost-benefit analysis ruled him out. So what? This is like arguing that we should ban abortion because we might miss out on another Beethoven. Well, yes, we might. We might also miss out on millions of unwed mothers in poverty. Are millions of mothers and children living in poverty worth a Beethoven? Well, maybe, to Beethoven lovers. But, hey, we might be missing out on another Beethoven just because you aren't getting pregnant right now!
You can see where that sort of thinking leads.
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I hate that americans are measured by their jobs.
I have a degree. I had a career. I worked since age 13(work permit) and paid into Social Security for all of those years.
I became disabled while working. I kept working. I went to get epidurals on my lunch breaks. Doctors I sat in conferences with were the ones who tried -and failed - too repair my spianl and neurological damage.
I'm now on medicare. I no longer "contribute to society". But I did. For over twenty years. My SSD benefit is based on the number of "work quarters" I contributed and the amount of my check that was removed and put into the pool. From that base number, approximately 150 a month is removed for SSD. Another 135.00 a month is removed from my work's long term disability insurance as a "medicare handler" PPO insurance. I paid for my pension, and I pay for my healthcare out of said pension. Medicare is not free.
But still,I am considered a "useless member of society, leeching off of the system",bebcause that is an American thought-form -- we are judged by what we do for a living, and when we no longer do something for a living, we are considered worthless and no longer "deserving". We were required to pay into a system that we are cursed when we need to draw from it.
I worked for a decade trying to cure cancer. Now no one gives a flying fuck about a 'leech on the system' when we are getting *the same government mandated retirement earnings/pension someone who retires at 65 earns, with the same benefits they earned* - but because we couldnt hack it until age 65 because something terrible happened, fuck us. And we get to do it in agony every day.
Yeah, wee, I get "free money" - when it wasn;t free - I PAID FOR IT? And the tradeoff is endless, incurable, unstoppable pain, nomatter how many injections they give me or surgeries they do or pills they feed me, and its barely enough money to live on anyway?
I'd trade this for a job with no insurance any fucking day of the week.
http://youtu.be/LnoD3NUux3M?t=50s
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It may be naive but from a foreigner pow the US system looks really like "As long as I have a good job I pay for the social cover of the other ones like me with a good job. If something bad enough happens to me, and I lose my job/cover/insurance it's bad luck, and i'm fucked."
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Consider Britain's NHS. The National Health Service is an interesting model. Some prefer it, some prefer a simple single-payer system, and some, such as myself, think that Obamacare is probably worth exploring on a practical level. The NHS largely avoids the problem of people dying for lack of treatment, but the large waiting lists for electives seems to imply that this is not without cost. In other words, there are only so many beds and doctors, and only so many hours in a day. As well, there have been questions over rationing and denial of services to some people:
Having recently been in and out of NHS establishments, once for emergency surgery and an extended stay, I can tell you now, we British love to complain about everything, especially in our newspapers.
And while we complain about the NHS, Nigel Lawson got it right when he said "The NHS is the closest thing the English have to a religion." We'll complain, we'll write snarky articles, but the attempted changes to the NHS are likely to lose the current government the next election.
Why? Because while there are issues, while there are failings, we believe having empirically experienced it, that the core idea is correct. Care, to everyone, man woman or child, young or old, cradle to grave.
By God, my own Grandmother, a lifelong conservative, would be out on the streets with a molotov before she'd let the NHS be tampered with. In fact she's old enough to remember when the doctor wouldn't even step over your doorstep without payment.
Much as I despise groupthink, Britain's people are inseparable from the NHS, because by and large we wouldn't trade it, especially for something petty like EVE subscription. You'll get no sympathy 'pon this isle.
(http://www.leftfutures.org/wp-content/uploads/2013/06/NHS-Olympics-image-e1372203056755.jpg)
Edit: Some additional newspaper perspective: http://www.theguardian.com/society/shortcuts/2013/jul/05/sixty-five-reasons-love-nhs (http://www.theguardian.com/society/shortcuts/2013/jul/05/sixty-five-reasons-love-nhs)
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Consider Britain's NHS. The National Health Service is an interesting model. Some prefer it, some prefer a simple single-payer system, and some, such as myself, think that Obamacare is probably worth exploring on a practical level. The NHS largely avoids the problem of people dying for lack of treatment, but the large waiting lists for electives seems to imply that this is not without cost. In other words, there are only so many beds and doctors, and only so many hours in a day. As well, there have been questions over rationing and denial of services to some people:
Having recently been in and out of NHS establishments, once for emergency surgery and an extended stay, I can tell you now, we British love to complain about everything, especially in our newspapers.
And while we complain about the NHS, Nigel Lawson got it right when he said "The NHS is the closest thing the English have to a religion." We'll complain, we'll write snarky articles, but the attempted changes to the NHS are likely to lose the current government the next election.
Why? Because while there are issues, while there are failings, we believe having empirically experienced it, that the core idea is correct. Care, to everyone, man woman or child, young or old, cradle to grave.
By God, my own Grandmother, a lifelong conservative, would be out on the streets with a molotov before she'd let the NHS be tampered with. In fact she's old enough to remember when the doctor wouldn't even step over your doorstep without payment.
Much as I despise groupthink, Britain's people are inseparable from the NHS, because by and large we wouldn't trade it, especially for something petty like EVE subscription. You'll get no sympathy 'pon this isle.
(http://www.leftfutures.org/wp-content/uploads/2013/06/NHS-Olympics-image-e1372203056755.jpg)
Edit: Some additional newspaper perspective: http://www.theguardian.com/society/shortcuts/2013/jul/05/sixty-five-reasons-love-nhs (http://www.theguardian.com/society/shortcuts/2013/jul/05/sixty-five-reasons-love-nhs)
I'm not sure how to respond to this, since it does not address a single issue I raised. I have not argued anywhere that we should dump Obamacare or that Britain should dump the NHS.
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Inference. You're saying why should I pay for someone else's health? Logic would point to the conclusion of you wanting to get rid of Obamacare.
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As someone preparing to move to the US, thanks guys. You're scaring me :P
So, let's see. Unsurprisingly, Vikarion is taking the hardline, pure logic approach and doing terribly at presenting it. Never go into marketing, dude, you'd be horrible at it ;)
Let's extract a few interesting issues here that have been kind of skated over. The core issue is, at the end of the day, one of resources. They are not endless, and that's a problem that's becoming more awkward in every area as the world population grows. Some kind of priority system is thus needed. Ollie talked about how this already happens - there might be a basic premise of 'help everyone', but investment vs result considerations apply. Something did spark my interest in his post though - essentially, 'euthanasia is bad'.
Allow me to open a can of worms: why?
Why is it more justifiable to leave someone living in agony and/or up to their eyeballs on medication, than to give them peace? Why is it ok to turn off a life support machine for someone who will never awaken, but not to allow someone living half a life to depart on their own terms? Why are we more humane to our pets than to some humans in the same circumstances? If someone wants to die, and their continued life is only going to be a drain on resources (and in most of the stories one hears, on the emotional fortitude of their loved ones), then why is it morally 'wrong' to allow them to? Life is not some sacred gift that must be treasured and preserved at all costs.
I'll clarify that last bit before the pitchforks come out - life is important. It's our most important possession. Letting go of it should not be done lightly, and there is a vital difference between not wanting to live, and wanting to die - a question that applies to suicide in general, not just euthanasia. The former is apathy. The latter is a choice. It's just not a choice that we're generally allowed to make.
Speaking of choices.
Eugenics is distinctly dubious road, and I'm not going to amble down that particular discussion, but there is a related consideration - genetic screening. Technology has advanced to the point where we can trace a lot of genetic diseases, quite apart from the more primitive side of family histories and such. I can remember a number of years back a fairly heated debate over here about whether people should be allowed to screen out unborn children based upon any conditions they might have.
I was, and still am, in favour. I'm not a sideline watcher here, either - I have a pretty serious genetic disorder myself. I'm just a carrier, but my mother has the full form, and it's not remotely pretty. I have voluntarily removed myself from the gene pool on that basis - I intend to never have children, as quite apart from other considerations, I have no interest in allowing that gene to continue.
I can remember being asked how I would react if someone with a genetic disorder had come up to me and said "If they'd done this, I wouldn't be here to speak to you." My response was essentially "But you are. Your point?"
I suppose the point underlying both of these topics, and others that I haven't raised, is that there's a strange obsession with 'life at any cost'. Not everyone necessarily believes that in private, but that is the dominant moral judgement from what I see in the world, and it's really dumb. Life is not the be-all and end-all.
One final amusing tidbit for the non-americans: Obamacare, that harbinger of the apocalypse if you listen to the Republicans, is actually based upon a system instituted in Massachusetts by their former governor. That system had a similar little moniker - Romneycare.
US politics is so very silly.
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Pretty much yeah.
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Inference. You're saying why should I pay for someone else's health? Logic would point to the conclusion of you wanting to get rid of Obamacare.
It's relatively easy to argue why one should pay for other's care, so they will pay for yours, of course. If my own health were a certain thing, I would not give a cent for that of others. However, no one can be certain of any such thing.
The argument is why I, living in a healthy manner, should have to devote resources to those who abuse their health. Or, to put it to another situation of recent note, why should a well-run and healthy corporation have to bail out a corporation that has invested in such things as sub-prime loans?
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As someone preparing to move to the US, thanks guys. You're scaring me :P
So, let's see. Unsurprisingly, Vikarion is taking the hardline, pure logic approach and doing terribly at presenting it. Never go into marketing, dude, you'd be horrible at it ;)
Somewhat fun fact: I actually do produce marketing materials and do client related work in my business. And I'm good at it - judging from how our clients react, I think. I just see no reason why I should need to be acting here.
Or, rather, I didn't. I had no idea people felt emotional about healthcare issues. I'm honestly surprised. :|
euthanasia stuffs
I completely agree with voluntary euthanasia. I've been put to sleep for surgery before (which I paid for out of pocket, btw), and it was far more enjoyable than many deaths.
I'll clarify that last bit before the pitchforks come out - life is important. It's our most important possession. Letting go of it should not be done lightly, and there is a vital difference between not wanting to live, and wanting to die - a question that applies to suicide in general, not just euthanasia. The former is apathy. The latter is a choice. It's just not a choice that we're generally allowed to make.
Heh. My life is important. Other people's lives are incidental. :P :twisted:
More to the point, are you trying to argue for it as a choice for the individual, or a choice for the society to impose on the individual - i.e., you are costing us too much and goodbye?
Eugenics is distinctly dubious road, and I'm not going to amble down that particular discussion, but there is a related consideration - genetic screening. Technology has advanced to the point where we can trace a lot of genetic diseases, quite apart from the more primitive side of family histories and such. I can remember a number of years back a fairly heated debate over here about whether people should be allowed to screen out unborn children based upon any conditions they might have.
I was, and still am, in favour...
Agreed. I think women should be able to have an abortion for any reason. An abortion to avoid a child with Down's Syndrome, Cystic Fibrosis, or other problems is not only a great way to avoid a lot of misery, it also avoids imposing more costs than necessary on society.
US politics is so very silly.
No shit. Now we have Republicans screaming "let us have our way or the government defaults!"
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Let's extract a few interesting issues here that have been kind of skated over. The core issue is, at the end of the day, one of resources. They are not endless, and that's a problem that's becoming more awkward in every area as the world population grows. Some kind of priority system is thus needed. Ollie talked about how this already happens - there might be a basic premise of 'help everyone', but investment vs result considerations apply. Something did spark my interest in his post though - essentially, 'euthanasia is bad'.
It's not that it's 'bad'. Apologies if that was either the literal or contextual way I phrased it.
It's just that from the perspective of a doctor, whether or not we believe that it's a patient's right to choose to die, we can't actively assist them to do it because of laws that make it illegal (in my part of the world) and the oaths we take as doctors. Principally the one that states 'first, do no harm'.
Giving someone (or teaching them how to/prescribing for) a lethal dose of medications specifically designed to first dull their senses and then stop their breathing is characterised as doing harm, ethically speaking. It's also defined as first-degree murder under our legal system.
Informing the patient of risks and outcomes of all treatment options and then withdrawing all medications and treatments after the patient has advised you to (either verbally or in the form of a pre-signed advanced health directive - which we encourage all patients to do), providing only those measures that ensure comfort and dignity inevitably accelerates the deterioration of a terminally-ill patient while still fulfilling both the Hippocratic oath (don't harm by overtreating) and the letter of the law.
The difference is largely about perspective. I've got no problems with the latter and have advised on many occasions that it may be the best option in certain cases.
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It's not that it's 'bad'. Apologies if that was either the literal or contextual way I phrased it.
It's just that from the perspective of a doctor, whether or not we believe that it's a patient's right to choose to die, we can't actively assist them to do it because of laws that make it illegal (in my part of the world) and the oaths we take as doctors. Principally the one that states 'first, do no harm'.
Giving someone (or teaching them how to/prescribing for) a lethal dose of medications specifically designed to first dull their senses and then stop their breathing is characterised as doing harm, ethically speaking. It's also defined as first-degree murder under our legal system.
Informing the patient of risks and outcomes of all treatment options and then withdrawing all medications and treatments after the patient has advised you to (either verbally or in the form of a pre-signed advanced health directive - which we encourage all patients to do), providing only those measures that ensure comfort and dignity inevitably accelerates the deterioration of a terminally-ill patient while still fulfilling both the Hippocratic oath (don't harm by overtreating) and the letter of the law.
The difference is largely about perspective. I've got no problems with the latter and have advised on many occasions that it may be the best option in certain cases.
It sounds like you are sacrificing a patient to the unavoidable throes of extreme pain and suffering for the sake of your own peace of mind.
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It's not that it's 'bad'. Apologies if that was either the literal or contextual way I phrased it.
It's just that from the perspective of a doctor, whether or not we believe that it's a patient's right to choose to die, we can't actively assist them to do it because of laws that make it illegal (in my part of the world) and the oaths we take as doctors. Principally the one that states 'first, do no harm'.
Giving someone (or teaching them how to/prescribing for) a lethal dose of medications specifically designed to first dull their senses and then stop their breathing is characterised as doing harm, ethically speaking. It's also defined as first-degree murder under our legal system.
Informing the patient of risks and outcomes of all treatment options and then withdrawing all medications and treatments after the patient has advised you to (either verbally or in the form of a pre-signed advanced health directive - which we encourage all patients to do), providing only those measures that ensure comfort and dignity inevitably accelerates the deterioration of a terminally-ill patient while still fulfilling both the Hippocratic oath (don't harm by overtreating) and the letter of the law.
The difference is largely about perspective. I've got no problems with the latter and have advised on many occasions that it may be the best option in certain cases.
It sounds like you are sacrificing a patient to the unavoidable throes of extreme pain and suffering for the sake of your own peace of mind.
Not at all. Sacrificing a patient to 'unavoidable throes of extreme pain' (quite emotive for you Vik :) ) for my own peace of mind would go against that principle I was talking about - do no harm. I've sacrificed plenty in my career but never any of my patients.
One of those comfort measures I mentioned includes provision of adequate pain relief and sedation, usually in doses or via routes that aren't used in patients receiving them for other reasons. There are methods beyond pharmaceutical management too, of course. Palliative care specialists are very good at their jobs, by and large. Results aren't 100% 'good deaths' but in the right hands it's close.
It's worth pointing out that results for euthanasia aren't either - the latter isn't quite the rosy picture of 'peacefully going off to sleep' that a lot of advocates like to universally paint it as. Potassium-based infusions, for instance, which are a staple of some regimens are far more likely to cause those 'throes of extreme pain' you described than a sub-lethal subcutaneous infusion of morphine in combination with midazolam given as comfort measures.
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Not at all. Sacrificing a patient to 'unavoidable throes of extreme pain' (quite emotive for you Vik :) ) for my own peace of mind would go against that principle I was talking about - do no harm. I've sacrificed plenty in my career but never any of my patients.
Hah! You should speak with my dentist. I never want to get a root-canal without painkiller again. :P
...mostly. Part of me wants to see if I could take it a second time.
I wasn't aware that pallative care had advanced so far. As far as I could tell, my grandparents were not particularly comfortable when they died. As for me, I want control over my death. I don't want to pass peacefully into sleep and die, I don't think. I'd prefer to determine when I die, and how.
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Not at all. Sacrificing a patient to 'unavoidable throes of extreme pain' (quite emotive for you Vik :) ) for my own peace of mind would go against that principle I was talking about - do no harm. I've sacrificed plenty in my career but never any of my patients.
Hah! You should speak with my dentist. I never want to get a root-canal without painkiller again. :P
...mostly. Part of me wants to see if I could take it a second time.
Heh I meant to ask you about that earlier ... it's not an uncommon thing that patients complain about: ie, 'That goddamned Dr. X doing his work hurt like hell and the local anaesthetic didn't do a damned thing'. What I've found is that a lot of colleagues get by by reassuring their (justifiably) angry patient that 'Well, you must be resistant to the LA' or 'Oh, you must be one of those people anaesthetics don't work on'.
Which is true in some patients ... if you're talking about a general anaesthetic that's subject to first-pass metabolism and other means of elimination that's patient variable.
But local anaesthetic? That's supposed to be injected in and around the specific nerve you're trying to anaesthetise. Just about the only reasons for that not to work is inadequate dosing, presence of abscess or localised/contained infection and ... poor knowledge of nerve anatomy (ie, person giving it doesn't know where the nerve is). And really? Part of a root canal is ablating the end nerve that's causing the pain so the dentist should know that anatomy like the back of his/her hand.
More than most of the other things you described I felt bad when you revealed that, because drilling a nerve when it's not been adequately anaesthetised is negligently cruel.
Added to address Vik's edit regarding palliation:
Yeah, I think it comes down to the fact that oncology research is probably the most heavily invested in of all medical fields. And palliative medicine is linked with that. Sure it's not getting the attention that potential advances in curative treatments see, but there's a realisation that however good those curative treatments are there's likely to always be a percentage who either fail treatment or weren't curative to begin with.
Again, there may well be differences too in the system where you are and your grandparents were and where I am. For instance, in most hospitals - large and small - that I've worked in there's access to a palliative care specialist for advice with end of life measures and determining how to 'get it right' for the patient. Sometimes there's an on-site presence while at smaller hospitals there's usually either a tele-health presence (again, covered by our tax-payer system) or a local GP who's had additional post-grad training in palliation medicine.
So my opinions on how palliation vs. euthanasia works might all be informed around how it works within my local context and having said that I don't think that a blanket application of everything that works here will work in other places.
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More than most of the other things you described I felt bad when you revealed that, because drilling a nerve when it's not been adequately anaesthetised is negligently cruel.
Don't feel bad. I am very resistant to painkillers, so there wasn't much that could be done. Also, I kinda enjoyed going up against that sort of pain and beating it. I will admit that it (a molar root) was one of the more painful things I've done, and I think I even had a slight emotional reaction to it, although I'm not sure what. It was extraordinarily odd. As for the drilling, that was pretty bad, but I think my least favorite part was when they filed the nerves out of the three canals. All because a cavity came in from the thin side instead of the top.
Anyway, what do you actually think about voluntary euthanasia, or assisted suicide, Ollie, provided that it isn't a doc providing the drugs?
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Anyway, what do you actually think about voluntary euthanasia, or assisted suicide, Ollie, provided that it isn't a doc providing the drugs?
It's hard to get the type of drugs we're talking about without prescribers being involved at some point, although the internet in recent years has made it easier.
But ignoring that and just addressing the specifics of the question:
I'm not opposed to it under specific conditions and I think I understand what might drive the desire for it. As I said 'do no harm' is an ethical principle, which means it's fluid.
I think my main concern (without the assistance of medical input) would be safety, which largely revolves around the issue of medical education - specifically the information and knowledge required to do it successfully with the lowest risk possible. 'Risk' in this sense being 'doing it without complications and without additional distress'.
The internet's a 'sometimes useful' resource in this sense, particularly in countries where the practise is deemed criminal. But it's a double-edged sword - most people aren't able to differentiate good information from bad information and having 'information' is distinct from having 'knowledge' in this sense. That confusion is where my concern comes from.
I don't know whether it can be done safely without some form of medical input or not, as a result.
What you specifically don't want to see are people in extreme circumstances who see this as their only hope or option and who end up making things worse for themselves or having themselves or their loved ones go through additional undue distress because something goes wrong and things don't turn out quite 'as advertised'.
There are secondary considerations too (less important to the particular question you had): to what degree are mental health issues (depression, mood and affect) impinging on insight, judgement and so on? What's the impact on family and loved ones? These and multiple other issues inevitably come into play in many individual cases, which I believe makes it more difficult for governments to propose legislation on. That and the divide of thought on it amongst most medical professionals.
Of course, if we're speaking more practically, one person can't stop another from either committing suicide or assisting someone in their attempt if the belief that it will resolve their situation is held strongly enough. I can't stop anyone with resources and access to information from doing this any more than I can stop someone putting a noose around their neck or putting a gun to their head and doing the same. There are also very few, if any, counter-arguments that are valid when dealing with someone who is in command of their faculties, knows they're terminal, wants no further treatment and is content with the quantity of life they've gotten. Outside of the few places that have legalised euthanasia, I don't envy anyone caught in that situation - it's miserable and there are no outcomes that don't have a negative attached to them.
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On the political point, I'd like to make a bit of a segue here to explain the political situation. There are a lot of people outside of our country whose lives and economies will be directly affected by a U.S. government default, so I'd really love the blame to land right where it ought to.
The Senate seems to be progressing towards a deal, but everything right now is being held up by the Republican caucus in the House of Representatives (our House of Commons). Since there are more House seats than Senate seats, the House tends to be selected by smaller and thus less conciliatory groups, thus creating non-conciliatory congressmen. Since senators are elected at least by half of a state, they tend to be more moderate and professional.
What is happening is essentially that the House Republicans are attempting to ape the rest of the government by rejecting any budget proposal that funds the Affordable Care Act. While they don't have anywhere near the power to repeal it, they've decided to play chicken with the nation's finances to try and force Democrats to remove it. The Affordable Care Act is, essentially, creating a virtual marketplace for insurance for the otherwise uninsured or under-insured, then requiring health insurance coverage by law. The virtual marketplace is going to be full of insurance companies' rated plans, but to make sure they are price- and benefit-controlled, the government will be installing their own plan there. That sets a sort of bar to follow for the other companies to make sure the uninsured aren't being stiffed when they have to buy insurance.
The aim of all of this is to bring health care costs down by essentially eliminating the uninsured simply not paying medical bills that they can't afford, since that was what health care companies were blaming for high prices of medical care (essentially that the insured have to pay the entirety of costs since you can't just let people die in the street because they aren't covered, but someone has to pay for all that). It's also meant to dictate a certain level of insurance must be met, as failing to reach these standards mean that someone who has insurance provided by a company can then go to the marketplace and deny their employers' insurance companies their money.
Nobody was ever a big fan of the ACA simply because it either was the first step on a slippery slope or didn't go far enough. Republicans fall into the former category as a whole, since they think government-provided insurance will simply crowd out the market and will eventually lead to a single payer system. Democrats essentially have accepted that it's the best they're going to get, but plenty would like to see us with a form of the Canadian system or British NHS. Say what you want about scheduling your checkup, right now Americans are paying something like 40-50 percent more than the next country in line in terms of expenditures per capita, and are consistently ranking between 20th and 40th on health care outcomes, depending on the survey. I'm not sure whether the question is whether our system works better; it clearly and demonstrably doesn't.
The real debate seems to be what we can afford, since nationalizing the healthcare system in America isn't just hard politically, it would also be ridiculously expensive. I work as an architect in health care and my mother's side of the family is almost all engaged in some way or another in medicine. I've worked desk jobs in private practices when they needed a hand and worked weekly at a free clinic here in town. Nationalizing the service would be expensive and the first few years, when all of the Americans who are ignoring or hiding what might be serious medical problems, might all suddenly hit the doctors at the same time.
In the meantime, the ACA is also Obama's centerpiece of his administration. It's a massive step into health care for our government and a giant slap in the face to previously bulletproof insurance companies and HMOs who were sitting somewhere just beneath lawyers on the vitriol scale. The idea of what we can afford or not seems to be the big issue on one side, with social responsibility on the other side. Some people try the idea that the government just can't run a health care system efficiently, though they'd really have to be trying to even match our system in terms of outright ineffectiveness.
All in all, American health care funding is a giant, disgusting mess and a huge reason I was looking (and am still looking) for a way out of my own country. Having essentially grown up with the system, I could see how shockingly broken it is when people have to wonder whether or not they should go to a doctor. Even if they can afford the copays to see a doctor, they probably can't cover their deductibles if there actually IS something wrong. So why bother? Last week, we had a guy come in to the free clinic with a melanoma the size of a golf ball on his back. So to see the House of Reps actually ready to send us into default in order to block a program that makes health care in any way more attainable has made me seriously rage.
However, we have to keep in perspective that it's not every Republican that's pulling this off. Mitch McConnell is doing his best in the Senate to come up with something, though there's no reason to believe the House would take the bait. There's a serious fight going on within the Republican caucus in the House itself, so some of them don't think holding the government hostage and threatening to shoot it is acceptable. I would say most of the Republicans that I personally know are just hoping this is a stunt, because even the ones who hate the ACA don't seem to be on board with this move.
There's actually a precedent for this. Newt Gingrich did almost precisely the same thing for precisely the same reason (though he cited Medicare as the reason for the shutdown). Clinton refused to pass a Republican budget and the government went into a shutdown in the mid 90s. It didn't turn out well for the Republicans, as Clinton then went on to win the following election with his highest approval rating since his first election (it did drop into the 40% range during the crisis though, nobody likes anyone during one of these shutdowns). Speaker of the House John Boehner (from my state) seems to know that this is really crushing his party's credibility, especially in swing states. However, he can't really do anything while tea party conservatives in extremely safe Republican seats that don't need to worry about re-election. They keep rejecting his proposals.
It will hopefully come to pass that the House will have enough votes to pass the Senate compromise, whatever it turns out to be. I'm not an economist, but plenty of people expect a default from the U.S. would send the world economy into a tailspin again. It seems like the outcome is going to swing on if something is going to pass the House majority. Which really isn't fair, because the U.S. having an economic hiccup isn't just "our" problem. Plenty of people outside of the continent are going to be feeling the effects if the value of the dollar suddenly drops and interest rates knock the legs out of the world economy. If they're going to have an ideological debate, I'm really hoping the House does it using some real and honest rhetoric, not by being irresponsible with our position in the world. Like it or not, U.S. politics aren't just U.S. politics anymore. We've actually got to keep the rest of the world in mind when we talk about our political situation.
Sorry, I've spent days without Internet angrily ranting about this stuff. It was going to come out somewhere.
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Newt Gingrich did almost precisely the same thing for precisely the same reason (though he cited Medicare as the reason for the shutdown). Clinton refused to pass a Republican budget and the government went into a shutdown in the mid 90s. It didn't turn out well for the Republicans, as Clinton then went on to win the following election with his highest approval rating since his first election (it did drop into the 40% range during the crisis though, nobody likes anyone during one of these shutdowns).
And yet, for some reason the budgets for 1997, 1998, 1999, and 2001 were all balanced. While the Republicans may not have won the political chess game of seats and the White House, they somehow managed to achieve the aim of slowing the rate of government spending (at least in comparison to revenues).
At this juncture it is however appropriate to blame the Bush administration and the 2001 Congress for not continuing to maintain balanced budgets into 2002 and beyond.
Edit: This does not change the fact that the Republican extremist are being retarded and playing exactly the tune set for them by Rupert Murdoch and a bunch of Saudi princes. :evil: :evil: :bash: :bash:
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Ollie, I wasn't specifically pointing at you with the 'euthanasia is bad' comment, more of a general remark on the conventional wisdom which the law seems to be based upon. Honestly, from what I'm hearing from you there's something of a system of loopholes already being used (I might be misinterpreting you, of course) which makes the entire thing even more silly. You already hear stories about people specifically going abroad to countries where it is legal just so that they can die.
I feel that I should also point out that your remark about the dangers about lack of knowledge and such wouldn't be present if it wasn't illegal for people who do know such things to be involved. It's a little like one of the arguments one hears about drug laws - one of the reasons so many people end up so fucked up by drugs is that they have no legal and safe recourse to use them. Not to mention that as a result, we also end up with nightmares like Krokodil... but that's another topic.
Also, Vik re: marketing; I was joking. Somehow I'm not at all surprised that that's your line of work. :P
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I'm not sure how to respond to this, since it does not address a single issue I raised. I have not argued anywhere that we should dump Obamacare or that Britain should dump the NHS.
Then you should practice your appreciation of context, and also avoid sounding like you're comparing an exclusively fee-paying system versus an exclusively tax funded system as if they were equal arguments. I think Anslo put it rather well; inference.
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I had no idea people felt emotional about healthcare issues. I'm honestly surprised. :|
That you can say this is a genuinely scary thought.
What deep, dark, internet-proof hole have you been living in for the last several years?
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I had no idea people felt emotional about healthcare issues. I'm honestly surprised. :|
That you can say this is a genuinely scary thought.
What deep, dark, internet-proof hole have you been living in for the last several years?
To be fair, there's a difference between knowing something and comprehending it. There's a lot of stuff out there that I know people theoretically get wound up about, but that doesn't mean that I'm any less surprised when I run into it.
...although Morwen still has a point here.
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I had no idea people felt emotional about healthcare issues. I'm honestly surprised. :|
That you can say this is a genuinely scary thought.
What deep, dark, internet-proof hole have you been living in for the last several years?
Oddly, now that I think about it, I'd mostly attributed the uproar to people hating the other "side", the other party, or the president. It just hadn't occurred to me that how one distributes medical care had emotional content for people, or that it should.
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I'm not sure how to respond to this, since it does not address a single issue I raised. I have not argued anywhere that we should dump Obamacare or that Britain should dump the NHS.
Then you should practice your appreciation of context, and also avoid sounding like you're comparing an exclusively fee-paying system versus an exclusively tax funded system as if they were equal arguments. I think Anslo put it rather well; inference.
From Page 3:
I'm not actually opposed to the ACA...yet. I certainly don't care for Republican policies either.
Page 4:
Or if you do want to place a limit, what better spot than at the point of sustainability, the point at which the cost of treating someone is less than their further contribution to society? Of course, our current system in the U.S. does far less than this (emphasis added) .
Page 6:
I'm not actually for a specifically privatized health care system. I'm generally of the opinion that most of the options we have right now are all bad. What I want to see is a system that provides care for reasonable causes (accident, injury, sickness) without providing care that essentially subsidizes the useless or stupid at a cost to everyone else.
Page 6 again:
My biggest concern is that it be an efficient and innovative system. The system in the United States is fairly innovative, possibly the most innovative, but it sure as hell is not efficient. That is to say, it is not providing good care for the majority of the citizenry...Right now, that occurs in the U.S. privately - you don't have enough money, you die...
Page 7:
First, let me clarify what I'm not in favor of. I'm not in favor of simply letting people die because they don't have enough money. Were it up to me, people like Kat would get treatment. An efficient use of resources is to distribute them where they do the most good. When the private market accomplishes this (as in most goods) the private market is best. However, there are areas where services and some goods are best allocated using other models, such as government.
Now, you guys must have a pretty special form of "inference" to get "Vikarion loves the current system and wants people to die" from that. As for arguing for a private system, I hardly think that trying to point out that we are still going to have to not treat some people under any system is a claim that a fee-based system is best. It really sounds like some people are reading what I've written more with an eye to assigning pre-determined meanings to it than actually absorbing the words on the screen.
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Well, Vikarion - I at least understand what you're trying to say. You once mentioned that you lack empathy and emotional attachment to situations, and I think that may be colouring your words a bit.
I still understand what you're saying though, and I for one don't think you're a horribly evil person. I've wanted to slap you a few times in this thread, but that's normal in political discussions. :D
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Well, Vikarion - I at least understand what you're trying to say. You once mentioned that you lack empathy and emotional attachment to situations, and I think that may be colouring your words a bit.
I still understand what you're saying though, and I for one don't think you're a horribly evil person. I've wanted to slap you a few times in this thread, but that's normal in political discussions. :D
Yeh. Wandering throught thread incoming!
In my fourth grade way of arguing a point, ;) people who get emotionally attached to a healthcare argument are people who have been emotionally effected /affected by the system - at some point it evoked a standing existing emotion.
A family member or friend couldn't afford care and suffered, and this makes someone angry and sad. Or they themselves are suffering, and this makes them angry or sad. That's basically how people get knee-jerk/emotionally invested in anything.
Healthcare can end up extremely personal, I almost want to use the word 'intimate' - as at the end of the day you are allowing someone else into your personal space and assigning trust to them over your body. You may not know what all those words on that patient information slip for all those drugs mean, you may only be readying the little colored tags hanging off of the bottles or boxes from the pharmacist/chemist, you might only have eyes for their white coat. (which for me better not be a short one, or I will degrade you openly in front of the nurses when you try and make a call in front of me -- research specialists/scientists are the WORST PATIENTS cause we dealt with those residents mussing up our labs.)
Though it is often said in the US that a patient should always remain in charge of their healthcare, especially these days -- like a puppy or kitten dropped onto a metal table at a vets office, most people flop out and surrender. The doctor knows something they do not, the patient is investing their trust, hopes, and future health in that doctor's care. We shop carefully for primary care providers. We research our surgeons and specialists - whether 'research' means looking up any work they may have done, or asking around in family and social groups for 'a good X-kind of specialist' - but that's as far as it goes, usually, as we have been slowly 'negatively reinforced' to avoid going further than a second opinion as such things start getting called 'doctor shopping' -= and then the doctors see that and go 'I'm already overworked, I'm not doing to deal with this asshole's internet phd.' The only reason I get away with openly challengng any of my doctors is when I tell them to look me up on Medline.
A major issue is that people aren't statistics - each person, though you can look at a list of symptoms and prescribe drug a,b,c for highest chance of success, until that 'statistical die' is rolled, which includes not only the drug itself, but the patient's biological system itself (which as I was taught, any biological system is 95% science and 5% witchcraft, as my mentor lovingly put it to cover that 'what the hell' that happens in any living system response to stimuli). at the end of the day, sometimes, medecine does not work.
And a medical diagnosis, holistically, is not simply symptoms. It is also the patient themselves as en entity, their social situation, their metal stability.
Yep. By that multi-axis disagnosis system, the meth-head was "unwell" before they took their first hit of meth. (watch things like The First Circle on Netflix for an idea of what I mean).
So yeh. We're stuck with a sieve method of who to treat and who to not treat because the healthcare system can't care for people it does not know are sick, or people who are "sick" one day and "well" the next (eggs are bad for you / no, eggs are good for you types of research), so people basically need to drop out of a pretty huge range of normal to be considered 'unwell' -- and once you're out of that range to get care in the US that isn't considered elective, you're actually pretty damned sick.
And as an aside, yikes people, I'm in palliative care. It's actually pretty damned good these days, despite my bitching, and I don't wanna die - i just wanna bitch about being stuck in it sometimes ;). I still have a life to live, lol.
EDIT: I also want to add - I've also been treated by the NHS, when I spent 5 months in London. I'm not sure which I prefer, to be honest. The NHS feels like an HMO equivalent to me, which even in my state lends me a sensation of 'okayness'. You'll wait a lot for a specialist but you'll get treated. Dental is NHS subsidized, which is even better (as in the US Dentists are pretty much cowboys, and it isn't included in medical, for those who don't know - it is its own separate insurance plan. For all the dumb teeth jokes, Brits are better covered in Dental than Americans without dental are.)
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Newt Gingrich did almost precisely the same thing for precisely the same reason (though he cited Medicare as the reason for the shutdown). Clinton refused to pass a Republican budget and the government went into a shutdown in the mid 90s. It didn't turn out well for the Republicans, as Clinton then went on to win the following election with his highest approval rating since his first election (it did drop into the 40% range during the crisis though, nobody likes anyone during one of these shutdowns).
And yet, for some reason the budgets for 1997, 1998, 1999, and 2001 were all balanced. While the Republicans may not have won the political chess game of seats and the White House, they somehow managed to achieve the aim of slowing the rate of government spending (at least in comparison to revenues).
At this juncture it is however appropriate to blame the Bush administration and the 2001 Congress for not continuing to maintain balanced budgets into 2002 and beyond.
Edit: This does not change the fact that the Republican extremist are being retarded and playing exactly the tune set for them by Rupert Murdoch and a bunch of Saudi princes. :evil: :evil: :bash: :bash:
I should point out that the reason the budget was balanced didn't have anything to do with the Republican Congress. I'd say that had to do with the tax hike that Clinton pushed through on high income earners coupled with his spending cuts. When the Republicans took over, they "cut" taxes and spending, but not nearly enough to go back to the way things were. Clinton vetoed the laws that would do that and essentially made sure they remained in some form or another.
It was weird, during the Gore/Bush campaigns, when we started talking about what to do with all of the surplus money we had. I remember everyone from Congress to SNL getting on Gore's case about putting that money away as savings in case something happened and we needed the capital. I remember wondering what the Hell he was on about during that campaign. Then, not long after, we seriously, seriously needed the money. And since we didn't have a surplus anymore, we just started borrowing. It's been that way ever since.
Between us and the EU, I think it's becoming clear that with the international economy growing more and more integrated, it's probably time to start working more collaboratively. We can't really look at our economies in our countries as their own little stand-alone islands; we're just too interdependent. A crash in China would wreak havoc on everyone's economies. So it's probably time to stop worrying about ourselves and to start really working on somehow working towards a better regulated international exchange. I think the EU's problem is that they just haven't gone far enough yet and need to start sort of combining their economies together more thoroughly. Right now, you have some countries that just aren't managing their euros well enough and it's hurting everyone else.
That's just my end though. I see that from afar, and it's not like the dollar isn't having its own problems right now.
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Republicans folded. And this is why you don't pick fights that are both stupid and unwinnable.
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Republicans folded. And this is why you don't pick fights that are both stupid and unwinnable.
http://swampland.time.com/2013/10/16/end-to-government-shutdown-senate-house-vote-obama-deal/
http://www.foxnews.com/politics/2013/10/16/senate-begins-vote-on-budget-bill-boehner-pledges-house-wont-block-it/
http://www.cnn.com/2013/10/16/politics/shutdown-showdown/index.html?hpt=hp_t1
http://www.bbc.co.uk/news/world-us-canada-24559869
http://america.aljazeera.com/articles/2013/10/16/hose-passes-billtoavoiddefaultreopengovernment.html
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Republicans folded. And this is why you don't pick fights that are both stupid and unwinnable.
I think I was kind of shocked that it went down the way it did. I can't imagine why the Republicans thought this would work when they had a recent example of it not working. When even members of their own party were pulling a WTF face.
I wonder if this dents the Tea Party influence on the House, since they're eating the brunt of the fallout. I think Mitch McConnell and the Republican senators will probably not come out of this as badly.
Maybe they just got a little too cocky, but I think that very vocal extreme wing of the Republican party thought they could do whatever they wanted. Kind of glad the rest of the party didn't line up to present face even when they knew it would be disastrous. This was really, REALLY not a good fight to pick and the absolute worst way to pick it.
I guess at least Congress has bought themselves another few months. Maybe we can look through all the shit we spend money on here and prioritize a little. We spend so much time fighting over health care and taxes because the parties both have some sacred golden cows they're not willing to sacrifice yet. I kind of figure the time when we could do that is over. We need to figure out what we need that we don't have, what we have that we don't need, and realign the balances. It's not like the government should be in debt, considering the sheer amount it takes in as revenue.
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\o/
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https://twitter.com/BBCMarkMardell/status/389723096925478912 (https://twitter.com/BBCMarkMardell/status/389723096925478912)
BBC snark best snark.
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Sadly, I don't think this is going to harm the Tea Party as much as it really should, because of the way the House collects seats: gerrymandering.
They've drawn their districts specifically so that they never, ever face any challenge from someone outside of the Republican party, because nearly all of their constituents are just as deaf, dumb and blind as they are and will happily vote for them again and again and again because the only people in those districts are people who will support them no matter what.
The problem will persist until sensible district lines are drawn and laws are passed to make gerrymandering illegal.
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Sadly, I don't think this is going to harm the Tea Party as much as it really should, because of the way the House collects seats: gerrymandering.
They've drawn their districts specifically so that they never, ever face any challenge from someone outside of the Republican party, because nearly all of their constituents are just as deaf, dumb and blind as they are and will happily vote for them again and again and again because the only people in those districts are people who will support them no matter what.
The problem will persist until sensible district lines are drawn and laws are passed to make gerrymandering illegal.
You do realize that the same technique keeps Democrats in office as well. It isn't just a Republican activity.
It is actually required by the voting rights act to gerrymander to create majority racial minority districts in order to ensure a certain number of racial minority House members get elected.
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You do realize that the same technique keeps Democrats in office as well. It isn't just a Republican activity.
While true, the Republicans did a much better (and more blatant) job of it in 2010. As such, 2012 was teh first time in US history that the party receiving fewer votes in House races ended up with more seats. I think the last count was that the democrats had something like 125-150 "safe" seats while the Republicans had damn near 200 - which is bad when a majority is 218.
Additionally, the democrats don't generally run quite such psychotic candidates, so it doesn't end up being quite as appalling.
At this point, my hope is that the Republicans will keep killing themselves for another 6 years to give the democrats a better shot at winning state elections in 2020. Maybe by then we'll have figured out some way to draw electoral districts (or get rid of them entirely) that isn't so open to abuse.
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In general we need to break the two party systems stragglehold on the system. But this will effectively require a bloodless revolution in which both extremes are soundly defeated.
This requires a 4th estate more interested in truth than the power of its financiers, a 3rd estate willing to appreciate truth and not seeking the echo chamber, a neo-2nd estate (scientific community) that the 3rd estate is willing to listen to and that can effectively communicate with the 3rd through the 4th.
I think the 4th estates alliance with the 1st is killing the neo-2nd estate and blinding the 3rd.
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UPDATE!
I just got back from the local clinic. Due to my income level, they only charged me a co-pay of $25, plus prescription costs. After speaking with the doctor and a quick examination, the Doctor determined that it was likely not the flu (because she hasn't had many other cases of flu in town yet) and was probably seasonal allergies. Apparently, allergies can cause fever, serious coughing, headaches, body aches, and all that other mess. I likely do not have pnuemonia, and the noises in my chest are probably the result of inflammation and post-nasal drip from my clogged sinuses.
Either way, it's too late past the original symptoms to judge what the original sickness was, and we're going to focus on covering the two most likely scenarios:
- That it could be allergies. An inhaler of [something?] was prescribed to help the wheezing in my lungs, but costs $53 so I cannot afford it right now. It's on hold at the pharmacy for me.
- That it may have been flu/cold and we're going to treat any residual infection just to cover our bases. A prescription of Azithromycin 250mg was prescribed instead of Penicillin because of drug allergies. I'll take a daily regimen of this for five days which should clear up any infection and prevent a pneumonia issue down the road.
I also got a sinus flushy thingy. It's basically a big squirt bottle that I flood my nose with warm saline to clear my sinuses. That will be fun!
If in a week I am not feeling any better or if it gets worse, she wants me back in her office this time next week. So, hopefully we've all seen the last of this seasonal horror story, and I will once again be an unproductive member of the RP community inundating you all with terrible puns and Caldari grumpiness.
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You know what, the more I read about your case, the more it reminds me the shit I got the whole year until the doc found out what it was. Not sure if it was long enough to be chronic for you, but chronic coughing usually means 2 things and it is hard to find what it is usually :
- allergy to something, thus, an inhaler and stuff like that.
- gastric issues, which irritates the throat.
I was prescribed stuff for both, had to do an x-ray, nothing.
After 6 months I ended up to make a legion of blood tests to eventually find that I was positive to Pertussis (apparently coming back as I said earlier in the thread). I'm still recovering from it since it takes aaaaages to manifest itself, and then disappear. I just looked up the symptoms on wikipedia and apparently, it can involve The classic symptoms of pertussis are a paroxysmal cough, inspiratory whoop, and fainting and/or vomiting after coughing.[5] The cough from pertussis has been documented to cause subconjunctival hemorrhages, rib fractures, urinary incontinence, hernias, post-cough fainting, and vertebral artery dissection.[5] Violent coughing can cause the pleura to rupture, leading to a pneumothorax. If there is vomiting after a coughing spell or an inspiratory whooping sound on coughing, the likelihood almost doubles that the illness is pertussis. On the other hand, the absence of a paroxysmal cough or posttussive emesis makes it almost half as likely
So if you are coughing to the point of choking, or something unusual like that, keep that in mind. Considering the time it took them to understand what it was, and the fact that old vaccines are totally outdated now (I was vaccined...), well... I hope it's not that. It was annoying as hell, even if it was not really violent in my case.
edit ; apparently you already got one of the antibiotic against it.
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UPDATE!
Thanks for keeping us up-to-date on it. While it definitely spawned an interesting conversation, I appreciate you sharing the challenges you faced and what sounds like relative success you have had.
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UPDATE!
Thanks for keeping us up-to-date on it. While it definitely spawned an interesting conversation, I appreciate you sharing the challenges you faced and what sounds like relative success you have had.
Oh yeah. I know it's ridiculous, but finally taking a prescription antibiotic to knock out a 6 week issue makes me feel like I'm conquering a terminal illness. It's a really really encouraging feeling to know that it's finally and hopefully over.
On the other hand, now I'm kicking myself for not doing it earlier when I was actually miserable.
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On the other hand, now I'm kicking myself for not doing it earlier when I was actually miserable.
Hindsight is 20/20. Glad you are feeling better. :D
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Hindsight is 20/20.
Not for meeee! I've got the memory capacity of a sweaty doorknob. :(
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Hindsight is 20/20.
Not for meeee! I've got the memory capacity of a sweaty doorknob. :(
*fetches cleaning rag*
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Dental is NHS subsidized, which is even better (as in the US Dentists are pretty much cowboys, and it isn't included in medical, for those who don't know - it is its own separate insurance plan. For all the dumb teeth jokes, Brits are better covered in Dental than Americans without dental are.)
Yep, yep.
I currently have a tooth infection. A root canal I got about ten years ago has gone bad, which means I need an endodontist to fix it, and then my dentist will give me a new build-up and crown. Here's what I've paid/been quoted so far.
Dentist's Exam - $60
Lady at dentist's front desk writes me a referral to endodontist, plus prescriptions for antibiotic and pain killer - $19
Endodontist Exam - $90
Root Canal by endodontist - $900
Build-up - $280
Crown - $880
Total: $2,229
I don't recall what I had to pay for the prescriptions themselves.
I'm going to see if I can't get my dentist to just fix the crown instead of getting me a new one. Or I'll just skip the crown altogether until I can afford one.
Either way, if I seem on edge, it's because I'm in a ridiculous amount of pain right now. Tylenol with Codeine #3 is a pussy little pain pill - whatever happened to dentists who proscribed oxycodone?
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Too many threats of or concerns over "OMG STOP PRESCRIBING POTENTIALLY ADDICTIVE DRUGS" lawsuits, probably. Plus, if they put you on a shitty, useless painkiller, odds are you'll come back complaining it isn't good enough and they'll get to make more money off of you by prescribing more shit.
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Yeh, you won't get oxycodones without a serious, serious issue. With the street value at ~$1/mg or more for the pure drug the DEA has their jackboots planted very firmly on that matter.
One of the main issues with tooth pain though is a lot of is could be considered nerve pain anyway. Oxy and other opiates really do very little to fuck-all for that. If they feel you're in enough pain and dealing with muscular spasms they may offer a benzodiazepine along with the painkiller (usually valium). Depends on the doc though and if your jaw is in spasm.