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Principles for Allocation of Scarce Medical Interventions

Discussion in 'Political Discussion' started by IcyPatriot, Aug 9, 2009.

  1. IcyPatriot

    IcyPatriot ------------- PatsFans.com Supporter

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    #87 Jersey

    Principles for Allocation of Scarce Medical Interventions

    by Gavind Persad, Alan Wertheimer, Ezekial J Emanuel(Obama health care adviser)

    Principles for Allocation of Scarce Medical Interventions

     
    Last edited: Aug 9, 2009
  2. IcyPatriot

    IcyPatriot ------------- PatsFans.com Supporter

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    #87 Jersey

    Principles for Allocation of Scarce Medical Interventions
     
    Last edited: Aug 9, 2009
  3. patsfan13

    patsfan13 Hall of Fame Poster PatsFans.com Supporter

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    Looks like Palin nailed where these folks are headed.


    Combine this with the Obama vid stating that he want a single payer and getting rid of Private Insurance, and regretting that it might take 10-15 years to get rid of private insurance.
     
  4. PatsFanInVa

    PatsFanInVa PatsFans.com Supporter PatsFans.com Supporter

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    I don't suppose you troubled to read the entire article. Please provide any description of an ethical framework, including that of the status quo, that could not be assailed with the stamp of approval "Looks like [your name here] was right."

    Perhaps you should have read the conclusion as well....

    Frankly, if I am 80 and a 20-year old kid and I both need a liver; and I'm a six-drink-a-day guy and he is a tea-totler; and I've been exposed to hepatitis and he has not been; I hardly think we should both compete by lottery for the liver. Even less do I think that if I have more money or access to more money (via a better insurance situation) that I should get the liver. But that's the fact: if I'm not insured and the condition is not transpiring in the ER (i.e., it's a known condition,) I will be SOL under the current system. But fear not - I'm likely never to be diagnosed since I have little access to medical care in the first place.

    Clearly, since we are talking about scarce resources (and not, it should be pointed out, the average every-day interventions that most health-care is about,) it seems like a no-brainer that some system other than pure lottery is almost certain to be in play.

    Obviously the long-term challenge is to be able to grow our own organs etc., and defeat the scarcity of said resources technologically. But one needs only to scan our life expectancy, prevention of preventable deaths, infant mortality, and other universally recognized stats to determine that our care across society is allocated using irrelevant considerations.

    Keep trying to scare the old folks. Even this article -- written in a bloody ethics column in Lancet -- only tips the hat to "youngest-first" as one of several rational principles to be combined in a "framework, not an algorithm."

    The notion that a medical ethicist should have no place on Obama's health care team makes no sense. Any medical ethicist's writings will be repugnant when compared to a vacuum of bad things (after all, any health prioritization will result in bad things, but just the negation of all health care is bad-thing neutral, since no care is specified.)

    But the principle you point out -- youngest first -- indeed has a good deal of weight in this framework. If you can get 4 months out of an organ and somebody else can get 40 years, the framework proposed in this paper suggest that should be taken into account. Within Emanuel et al.'s framework, you have a weighted lottery, with attenuated chances at the golden ticket in your Wonka bar as you age (and prior to age 15.) As it stands we devote the majority of our care dollars to the first and last years of life. How fair is that to those in the middle of life?

    A final note, by the way: Nobody on Obama's health team has written any health care bill. That is being done in congress.

    PFnV
     
  5. maverick4

    maverick4 Banned

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    The study of allocating resources is much more humane than letting people die simply because they are poor.
     
  6. IcyPatriot

    IcyPatriot ------------- PatsFans.com Supporter

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    #87 Jersey


    Writings like this point out the need to have debate .... a long debate about this. What is angering people so much and rightly so is the speed with which the democrats tried to ram this bill through to vote. Congress has taken advantage of the Obama popularity to change the traditional methods of proper debate ... America rejects this. The left is being blamed for the outrage and actually it is the independants who are against this and by @ %75 margin and that's the swing area.

    How do you slow down a speeding train? With a loud rejection of the process. Anyone who does not favor debate is missing the boat ... now if only there had been more debate when Bush was in office --- yes --- that's what we need to get back to is debate.

    BTW ... the healthcare bill, Afghanistan projections, cap and trade ... America is waking up ... perhaps 9 years to late but waking up is better than dozing. Someone needs to pay and the rich are not as rich as they were a few years ago.
     
    Last edited: Aug 9, 2009
  7. PatsFanInVa

    PatsFanInVa PatsFans.com Supporter PatsFans.com Supporter

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    Well now, Icy, in a perfect world I may agree with you on the speed of the process.

    In the world we're in, we saw national health care reform die on the vine in the 90s, and we have seen in the various bills making the rounds that Obama chose the most palateable and least radical notions that will get the job done, jettisoning single payer for public option... which in itself is painted by our worthy board-mates and their ideological brothers-in-arms as somehow socialist or Nazi depending on the day.... when in fact SOME form of national health care is simply what civilized nations do (our own excepted.)

    I do agree with you that the pace is not optimal. But we're dealing with an opposition that says "hold on wait a minute" until the proverbial patient is nearly dead, then says "oh screw it pull the plug." That was their stance on the auto industry, with a liberal dose of "it'll never happen in X days anyway. HAH!"

    Here's Gallup's poll on reform: 41% say do it this year, 30% say do it but not necessarily by the end of this year, 21% say don't do it at all, and 5% say don't know or refused to answer.

    Most in U.S. Want Healthcare Reform, but Vary on Urgency

    Those who say reform it do not necessarily favor the bills they have heard of, if both the above 7/27 poll and this 7/29 poll are representative and valid:

    No Groundswell of Support for Healthcare Reform

    In this one, 34% say health care reform would worsen care in the U.S., and 14% say nothing would change.

    As we all know, what you ask matters. The first question seems to be a "should we get it done?" question, and the second one is more in line with expectations of results -- so there seem to be a good number of people who say we should give it a try but are just plain pessimistic. Some people apparently think we should get it done not necessarily this year... but that if it gets done it will worsen care. My guess would be they believe it should be done but that reading the present tea leaves, they believe it will be a failure if done at the present pace.

    Last but not least, Obama's approval rating went up 4 points week-over-week in the Aug. 3 poll:

    Obama Job Approval Edges Up to 56%

    PFnV
     
    Last edited: Aug 9, 2009
  8. IcyPatriot

    IcyPatriot ------------- PatsFans.com Supporter

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    #87 Jersey


    I'm hoping my favorite people ... the blue dogs get more say on this.
    As for your post above
    :eat3:

    Is your's Bud Light, Blue Moon, or Geritol ?
     
    Last edited: Aug 10, 2009
  9. PatsFanInVa

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    Geritol laced with arsenic by the OBAMA DEATH PANELLLLLLLL!!!!
     
  10. Patriot_in_NY

    Patriot_in_NY Veteran Starter w/Big Long Term Deal

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    Ezekial J Emanuel is not just an a health care advisor. He's it's chief proponent. The so called "Health Czar" if you will.

    He is a "Hoch and Binding" guy from many years ago. Mention that and you're label a fear-monger, but nonetheless, it's the truth.

    If you honestly think less "poor" people will suffer and die under a purely socialized system, your are 1) uninformed, and 2) clueless.

    Widening the bottle, and narrowing the mouth will force rationing. Rationing will put political considerations into medical decision. what could go wrong?
     
  11. PatsFanInVa

    PatsFanInVa PatsFans.com Supporter PatsFans.com Supporter

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    Welllll let's see what happens if we look for "Obama's health advisor," singular...

    Obama's health advisor clarifies the campaign's healthcare platform | Healthcare Finance News
    (October 2008)...

    Obama's Health Adviser Turns To Indiana For Answers - Staying Healthy News Story - WRTV Indianapolis

    Okay, Tom Daschle, in December 2008... still no Ezekial Emmanuel..

    It's all so confusing... Wonder what whitehouse.gov says...

    Get the facts about the stability and security you get from health insurance reform | Health Insurance Reform Reality Check

    Lower bottom video focuses on "Linda Douglass of the White House Office of Health Reform "... Well this helps. Wait though, maybe this is a longstanding office that doesn't have the real power... unless...

    The White House - Press Office - Executive Order Establishing The White House Office Of Health Reform

    Yes, this office was established in April 2009. So obviously there is a White House office for health reform, recently established, to deal w/policy matters... and its head must be Dr. Emmanuel...

    Curiously, it's one Nancy Anne DeParle.

    White House's DeParle Updates Health Overhaul - NPR Health Blog Blog : NPR

    Wait wait no I know, maybe this office isn't an important policy office... maybe he just set it up to show they're doing something but the real brain trust consists of a shadowy portfolio-less group only the rabid right knows about...

    Well, if that's the case, the rabid right should at least tip off HHS Secretary Kathleen Sebelius...she thinks this office needs coordinating with...

    Secretary Sebelius Announces HHS Office of Health Reform Personnel

    Of nine listed staffers in the HHS Office, none of them are Dr. Emmanuel.

    Now then, the salient points surrounding Dr. Emmanuel seem to be
    1) that he co-wrote an article recently in Lancet that focuses allocation of scarce resources, and that
    2) His last name is the same as the Chief of Staff.

    From this, the blogosphere, mass e-mailers, and morons who take this idiocy without fact checking it, have constructed the notion that not only a, but THE, chief health advisor in the land -- the "health czar," as the impressionable poster above puts it -- is Ezekiel J. Emmanuel.

    Well now, who is this enormously powerful man?

    The Department of Bioethics - Our People

    There's a link to his CV as well.

    This is an ugly and obvious example of the idiotic copy-and-paste circle jerk that is surrounding this hot-button issue. One moron decides to promote him from "an advisor" to "THE advisor," and now our local savants decide he is the "czar."

    Of course none of this appears anywhere on paper or the internet equivalent. Mainly because it does not exist. He is not the bloody health czar. He may be an important voice in the administration, especially given the family tie and the fact that he was on Clinton's health task force.

    As to the terrible horrifying paper in Lancet:

    This is about prioritizing use of scarce resources, not common resources.

    If you have 10,000 livers that become available per year, and 100,000 people who need a liver, 90,000 of them will not get the liver. Dr. Emmanuel's sin is thinking thoroughly, rationally, and compassionately about who gets the resources... and takes the additional step of disqualifying none a priori.

    Now then, don't you feel stupid about declaring him the Lord God Ezekiel Emmanuel, Czar of All Health Care?

    You should.

    PFnV
     
    Last edited: Aug 12, 2009
  12. Wildo7

    Wildo7 Totally Full of It

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    Behind nearly every right wing claim is a big bucket of lulz. Thanks PFinV. :banned:
     
  13. Wildo7

    Wildo7 Totally Full of It

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    Not just a health care advisor, but the CHIEF PROPONENT. The so called "HEALTH CZAR" if you will.

    Obama's Health Czar - TIME

    :ugh:
     
  14. PatsFanInVa

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    A veritable who's-who of health care reform, or perhaps better stated for our purposes, a veritable who's-Ezekiel-Emannuel of health care reform...

    Seriously guys can't you just do this before you say dumb things?
     
  15. IcyPatriot

    IcyPatriot ------------- PatsFans.com Supporter

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    #87 Jersey


    I did not say he was a czar ... I didn't say anything really other than to point out the source of the story the media was lit up with.

    I said "Obama health care adviser" ... and he is one of them.
     
  16. PatsFanInVa

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    Sorry, Icy, I take you at your word on that. I was responding to the guy a couple posts above mine, who promoted him to THE MAIN Dude, and declared him the "Health Czar."

    PFnV
     

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