Comments on: Pills Pills Pills

By: Susan Dunn

Susan Dunn — Fri, 26 Feb 2010 19:40:03 +0000

This has all been interesting to read. American medicine is so different than Canadian medicine. I am an Oncology nurse, I know that there are cancer drugs available here that are not available in Canada. My thoughts would be 1) because of the cost but 2) because these drugs in studies show only 1-2 months progression free survival data and cost thousands of dollars more than the standard care. We do this because this is what the public demands and buying time so that a person can live long enough to see a granchild born or their son graduate does seem the right thing to do. However the cost incurred is depriving many other americans from basic medical care. I recently read that depending on what state you live in the last 6 months of you life may medically cost 10,000-35,000. It all seems to depend on how many doctors, specialists and available ICU beds are available in the area you live.

By: Lawrence Verde

Lawrence Verde — Fri, 26 Feb 2010 18:47:17 +0000

Wow this is powerful insight from the inside. That’s what the system has done to the masses. Employer required health care eliminates the reality of coverage. People have no clue how much anything costs because it’s taken from their check before they see it and when the insurance is used it usually shows up as paid statement. Most often patients are insulated from the insurance and medical providers money dance. So there’s no real sense of costs for a majority of patients. People need affordable health care but there has to be a better way. A way to stop the “medical madness” of ridiculous insurance pay hikes and enormous economic risk by providers. It becomes their war; the patient is a pawn and doesn’t even know it. That needs to get fixed.

By: Lori T

Lori T — Fri, 26 Feb 2010 18:41:08 +0000

Oh so many things to say….. I just don’t think America is the same machine as Japan. America was built on freedom from government reign along with other freedoms. It seems like we are out of control on both sides of capitalism and social reform. What happened to the middle road? I don’t agree with socialized health care but I certainly believe we need reform. I want people to be well cared for. But here in America we have the highest obesity rates and diabetes rates per capita. Worse yet, having been in healthcare for over 6 years on the preventative side and now clinical I agree with Dr. Jeff more and more. The cost of the uninsured is costing hospitals, insurances, and businesses who provide health care so much money. I want people to have coverage, but the current plan fines businesses for not offering the govt. option and worse fines doctors for patients if the are multiple admits. Well the problem with that is, in critical care, most patients are re-admits for CVD, renal disease, and poorly managed diabetes. A lot of times these patients don’t have to worry about who is paying for it because the govt. and hospital picks up the tab, then the govt. again. They lack motivation to try and depend entirely on the govt. for their care. I have a problem with that when they are ultimately responsible for their health. Unlike the Japanese, who have a socialized view point and not only take pride in their health, they care for their brother; we as a society are self motivated and protect our own heritage (I don’t like this, but that is the way it is). What is even more frustrating is that this current bill is so intoxicated with fees, kickbacks, and more control to special interest groups that it doesn’t care about the community at large anymore but it does care about the interest of those in Washington. That has been our failing this entire time, across party lines. I am tired of hearing about parties, I just want the best for patients but protecting those in healthcare service. Govt. control is not the answer. Govt. support and accountability is, but defining pay scales and defining who does and does not get priority coverage is not. Nor is defining what is covered. That is out of control politics. I have read a lot of the bill that was issued last year and it is filled with this language. It just grieves my heart. I can’t even think about how much debt we are going to incur if this goes through. This cost will cripple America to the point where we will no longer have a international voice. We will owe to many countries to much money to argue if they want to take us over. This goes much further than health care for everyone. We need to be careful with our actions.

By: Casey H.

Casey H. — Fri, 26 Feb 2010 18:37:21 +0000

Jeff thanks for sharing the patient example (new stuff I’ve not read up on must read more about businesses going under thanks) and for sharing the link, will take a look and post myself or by all means feel free to share any of this. And Michael lots of good stuff, being the lay student of religious traditions that I am I like how you tied the moral argument in with religion back there.
When discussing future problems for Japanese health care with its aging population and all I asked one of the guys what the solution is, to which he says “Those with money will have to pay more”. While class difference here aren’t nearly as pronounced as there, I think it fair to say he’s upper middle class, or rich. He drives a BMW, has a nice house, etc. So I ask if he’s okay with that, paying more so others have the same health care he’s got, to which he answers “well duh yeah you idiot” (I’m paraphrasing, but a definite yes). No doubt the demographics between US and Japan are different, immigration problems and such. But scores here receive some form of social welfare too so there are similarities. Anyhow this guy is Buddhist and of course compassion is as much a precept of Buddhism as it is of Christianity, but based on what gets said you’d never know what religion he practices (I’ve a big interesting in comparative religion so I ask). It’s just interesting to me how, especially with our politicians, those who play the religion card the most seem to completely miss the fact that this guy whose name their claiming was a champion of the unclean, the sick, the poor, i.e. those without health care. Anyhow that’s an aside, just something that stands out to me, maybe a politics and religon geek expat perspective or something?

By: Casey H.

Casey H. — Fri, 26 Feb 2010 18:33:48 +0000

Like said at the beginning I initially shared this with the physicians here to guide discussion and show how silly the health care reform debate can get in the States – how politicians spread disinformation, etc. Two of the guys had lived there about a year, one as a high school student and the other more recently (he practiced at John Hopkins and moved back to Japan a few years ago). Thus they’ve experienced American culture firsthand but are still learning what makes us tick, so to speak.
As we were talking over the problems there one of them asked me “What is good about America”. He was asking in the context of health care, reforming it, etc. So a big thanks to you guys for giving me an excellent example of what I love about us. We won’t have time to read through this whole thing but I’m going to print it out and show them how, while many will just repeat talking points and remain ignorantly partisan, more and more of us will take the time to research and debate, learn and share facts and experiences, and work together to find solutions. And we’ll do this with total strangers, at a party or on a fb page. Very American, I love it! This is what an informed citizenry, one responsible of democracy, looks like in my opinion.

By: Jeff Shinoda

Jeff Shinoda — Fri, 26 Feb 2010 18:31:40 +0000

I agree with you whole heartedly, no-one should go broke because they get sick. As far as Sarah Palin’s “death Panels” I do believe that is her version. Where she got that I have no idea, and it does not hold any validity. And yes this is a fear based science fiction. As for your Grandmother, that is so cool about her history with the swing band. As far as her being 90 with cancer, her type of cancer may have been worth the treatment based on the outcomes. Remember the word cancer is a generic word. There are various types, cell types, and specific organs involved. This patient that is 91 her type of cancer, and the treatment outcomes do not offer her any cure or quantity of life. She will get the treatment and it will not improve her survival based on all the current literature and studies.
Michael, thank you for all the stimulating posts

By: Michael Parisi

Michael Parisi — Fri, 26 Feb 2010 18:30:40 +0000

So, of course, I would advocate the same treatment again, without question. Your ethical question Jeff is reminiscent of Sarah Palin’s “death panels”, and please correct me if I’m wrong, but as I understand it, her version states that, in the future, if govt controls your healthcare, you may be deemed unworthy of treatment based on your value to society. Of course, this is fear-based science fiction no better than any other dystopian sci-fi fantasy, and a real slap in the face to those facing the REAL death panels (rejected for pre-existing conditions or refusal to treat for any reason, including lack of ins).

Anyway, my larger point is, no one should ever go broke because they get sick. Ever. Period. It’s wrong.

By: Michael Parisi

Michael Parisi — Fri, 26 Feb 2010 18:27:18 +0000

Real quick: What would that same treatment cost in Singapore, I wonder? Medicare needs reform, no question. The Congressional Budget Office is providing the best numbers for the new plan, and it’s a realistic goal to have it paid for, as Obama has presented. No guarantees, because they just don’t exist, but it’s equally possible that the plan will do better or worse than projected. Standing around doing nothing is a guarantee things will get worse. We need to look at all the successful systems in place elsewhere in the civilized world, and have confidence that we can do just as well. I reject the notion that America can’t stand the moral high-ground based on obsolete business practices that do us no good at all.

Secondly, believe it or not, my Grandmother was treated for cancer, right around the age of 90! She did have complications, but they cleared up, and she lived for another six years. She loved watching sports and could talk up a storm on baseball/basketball until the day she died. She was also the drummer in the FIRST all girl swing band, back in the 30’s-40’s

By: Jeff Shinoda

Jeff Shinoda — Fri, 26 Feb 2010 18:24:06 +0000

Which then brings me to the cultural difference between Japan and the US. Casey, you will understand especially with all the budo training, but Japanese believe in the quality of life, not the quantity of life. Meaning it is not how long of a life you live, but how well you live your life. Hence, as we become old and frail and ultimately die,the acceptance of the death is part of the culture, thereby if this were a 91 year old in Japan, they would not want any treatment, and would rather live what life is left to the fullest. Hence the quality of life is more important than the quantity of life.

By: Jeff Shinoda

Jeff Shinoda — Fri, 26 Feb 2010 18:23:15 +0000

One more thing in regards to this patient, it is easy to say she should have the treatment, keep in mind, the treatment will decrease her quality of life, meaning the bad side effect which include not being able to preform certain tasks that she currently enjoys as well as can include an earlier death from an infection. We can give her the treatment, and actually cause her to die from other complications, and remember based on her age, the treatment will not extend her life ie: she will not get a cure from doing this. (remember she is 91 years old). This is the true ethical question, not the costs associated with her care. So to re iterate the ethics involved, do you treat because a patient wants treatment, even if their is no benefit and can possibly do more harm, including their quality of life?