From: J056600@LMSC5.IS.LMSC.LOCKHEED.COM
Subject: Re: Health insurance stuff
Organization: Lockheed Missiles & Space Company, Inc.
Date: Tue, 15 Dec 92 22:14:58 GMT

In <1992Dec15.175426.3957@island.COM>, Guido Marx writes:

>In article <13620@optilink.COM> cramer@optilink.COM (Clayton Cramer) writes:
>>In article <lii39iINN114@exodus.Eng.Sun.COM>, chased@rbbb.Eng.Sun.COM (David C
>>> It was pretty clear
>>> that the urgent care clinic cost more for less service.  I read
>>> somewhere (don't know where) that this pattern of getting medical care
>>> is more common than it used to be, and it is clearly not the cheap way
>>> to do it.
>>
>>Of course it's not cheap.  If it were, too many people would abuse it.

>I don't think so.  Under the insurance plan at my employer, we can
>visit a doctor and it only costs $5.00.  This includes the local
>urgent care clinic.  I have had occasion to use the urgent care clinic
>once in almost three years (I was running a 105 degree fever on a Sunday
>afternoon).  Our insurance carrier says that their studies indicate that
>when they make routine visits to the doctor cheap, people OVERUTILIZE
>their doctors for the first year.  After that, they go to the doctor
>LESS than people on traditional 80-20 plans.  Overall, I believe that
>making primary care cheaper would help to reduce total health-care
>costs.  The experience of our health insurance carrier bears that out.

I'd agree.  Part of the problem is that the people who benefit from health
insurance don't pay much for it.  The costs associated with it are hidden to
its consumers.  Only when free market principles are introduced can we expect
people to cut back on their consumption of health care.  Even if it's only
$5 here and $10 there, we are at least paying for a bit of the care which
will reduce demand for routine/unnecessary services accordingly.

>However, if we are going to get a handle on our nations health care costs,
>we are going to have to come to grips with how people in our country die.
>We spend a HUGE ammount of our health care dollars on the last week of peoples
>lives.  My grandfather was a case in point.  Until he contracted cancer, he
>had never been in a hospital in his life (he was born at home).  His total
>medical bills totaled over $85,000.  Approximately half of that was spent
>in the last few days of his life.  At that time, the cancer had metastasized
>and the only appropriate treatment IMHO was drug administration to control
>pain.  Instead, there were surgeries and other invasive procedures.  As
>well as totally inadequate pain control.  I am sure that this scenario
>plays itself out thousands of times each day - and it is one of the major
>forces driving up the cost of health care.

I'm not a fan of physician-assisted suicide (active euthanasia), but I do think
that letting terminal patients die with much less pain (passive euthanasia) is
a very good idea.  Although I have a healthy respect for life, what purpose is
served when we spend $10,000 on a procedure which will only result in one more
week of excruciating pain?

I'm not talking about rationing treatment or refusing treatment to over-65
people as they do in order to control costs in some European countries.  I
refer only to the terminally ill with *very* little time left.  I think that
the only appropriate treatment in such case is to administer megadoses of pain
killing drugs and let the patient die.

In the case of your grandfather, what purpose was served by performing very
expensive surgeries which (at best) will extend a very painful existence by a
few days or weeks?  As you stated (with which I agree), the appropriate
response would have been (a) control the pain with very large doses of pain
killers (how much harm could an overdose do to a patient in extreme pain with
less than a week to live?) and (b) keep the pain killers coming until a more
peaceful death ensues.

In a related note, this is why I'm infuriated when the FDA rejects a drug
which may reduce pain and/or even cure terminal diseases.  Some drugs get
rejected because they are "too dangerous."  Maybe for a normal healthy human
being, but for a terminal patient in extreme pain?  What's the point in
withholding treatments which may help and which can't do much harm?  Why
shouldn't an AIDS patient with two months to live be given a chance to try
something which may--no matter how slight the probability--help them?


Tim Irvin
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