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December 07, 2008


You've asked an interesting question. My take has always been more toward quality of life rather than quantity. What good is it to live into your 90s if you don't feel well?

In engineering, we were tempted to tell our customers that they could have something...good...fast...cheap--pick any two. We could do practically anything that anyone could want...and...we could do it quickly; but, if they got a quality product, quickly, it would not be cheap.

In life, we must make choices. My personal choice is to have fewer people...but...people who are well-off and long-lived. However, at 6 billion + people, we, as a species, have long since opted for lots of people in oft-times squallid, unhealthy conditions. We struggle to find better ways, don't we?

I think any serious discussion of universal health care has to include an upfront discussion of what is to be included. As technology raises the level of possibility, we will surely be asked over and over which of those technologies should and should not be covered.

I have felt we have to evaluate whether we are extending dying or living. We now can have someone spend 5 years dying with one major treatment after another but their quality of life, as mentioned, is painful and suffering. This won't be popular with the sort of people who wanted to keep the totally comatose woman alive in Florida (and elsewhere). The fact that insurance will cover it should not be the only criteria. Also there is a problem with some people who run to the doctor for every little thing. Where do we draw the line? It won't be easy to work out realistic health care but the main change should come with children and being sure they get basic, workable treatments as well as all vaccinations. After that can come the rest of us. The emphasis, because of the lobbying power, on seniors might be coming at the cost of those who can still live productive lives but have something which could be treated but they can't afford to do that. None of this will be easy or popular. Without this kind of thinking though health care costs will bankrupt us and for what?

AQ & Rain--As usual, I agree with each of you in your comments. It may not have been clear in my "...choice is to have fewer people...but...people who are well-off and long-lived." I do not believe in breaking the bank on end-of-life expenses. My cost benefit analysis is such that, if I am unable to tell a physician that I wish to have a surgery, none should be performed. I'm old enough that most surgeries can only be expected to prolong my dying.

Painful and difficult subject. My mother is 87 years old, totally disabled, in constant pain and, in my opinion very depressed. But her grip on life is incredible and despite every medical emergency over the years she continues to keep on going with a mind that still works. She pays a nursing home quite a sum to look after her each month. If she was unable to do so she would have to fill an NHS bed, so preventing someone else from filling it and receiving medical help. The problem is that just because someone is old and ill it does not mean that death will come easily, leaving real life to those with the capacity to enjoy it. I read the bits you have quoted, CopCar, and I'm afraid that I had read that this doctor would expect someone to make a decision on who should live and who should die. Not an easy subject and I am far from sure I have any answer.

Adele--If one has a national health care system, someone must decide who gets what. How we expect the populous to agree with/on such decisions is beyond me. Thankfully, your mother is of clear enough mind to make her own decisions, and seems capable of communicating them to others. Would that all elders were equally able, not to mention that they be able to afford private care, as your mother can.

Hmmm... When I wrote the above yesterday I could not remember ever being aware that the NHS has a policy on when to justify and when to limit medication. However, later in the evening I remembered that the doctors at the Cardiff hospital my mother was in said that given her physical condition and medical history they could not offer her more than palliative care. In her case I assumed it was because there was nothing else they could do, without medical procedures and medication causing additional problems to her several chronic conditions and problems that have to be managed daily. However, on due reflection they could have meant something completely different.

One of the problems with our NHS is money. Despite a significant amount of taxpayers money being plowed into the service every year it is never enough to provide all the expensive medications and services that could be made available to everyone. Decisions always have to be made on priorities. As you said someone has to make a decision on what to provide and to whom. Over here the NHS is broken down into regions, each of which has a certain degree of choice in what is their top priority to receive funding. And what do the media call this? "A Post Code Lottery". Ha!

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