Friday, October 26, 2012

Chapter 32 As October Ends . . .

Chapter 32

As October ends,

Laura’s Journey,
 is the one to remember

The Journey

Two posts from Laura's Blog

Hebrews 10:39-

"But we are not of those who shrink back and are defeated, but of those who believe and are saved."

December 20, 2011

By Laura

Hey there fellow bloggers…friends…family, whoever you may be.

This is my first ever blog post- and already I am quite frustrated because I had already written out my whole post and then tried to post it and the site made me log back in….gah. I have always been against this whole blogging thing…but I have recently felt led to share with the world my story, with the hopes that maybe-just maybe- someone may be inspired. I want to be REAL with you…honest and open about what is going on.
I was recently told that I have a limited time to live. It has been four and a half years since the nasty disease called osteosarcoma (aka cancer), decided to take over my body. It has been a long and tough battle, but four times, I have made it through. With the Lord and my friends and family by my side, I have come through the other side healthy and happy. This past Wednesday, though, my family and I got the news that my cancer has returned, and is filling up my lungs at this very moment. I can feel the pain from one of the tumors pushing up against the inside of my lung cavity, and my breathing is raspy from the fluid filling up my lungs. “Prognosis is really bad,” says Dr. G. I have already received basically everything that they can offer, which has resulted in kidney failure and a number of other problems. My options now are extremely limited, with the next steps being surgery and then searching to find a clinical trial somewhere that I could qualify for. It’s definitely scary, having to basically search for all of this info. My treatment is in my control, and now I call the shots. All of my decisions now are shifted to “quality vs. quantity.” That is, everything I decide has to be based on if I want a higher quality of life, or if I want more time. How am I to make these decisions? I have no freaking idea. I have no answers to any of this. All I know is that from now on, I want to truly LIVE…even if that means I may have less time. For all I know, I could come out of this and 60 years later I look at this as a distant memory. But I don’t know that for sure, and there’s no way anyone can know. I definitely still believe that God can heal (I even went and got a tattoo this week…its “jehovah rapha” -the god who heals- inside an infinity symbol.) I KNOW God can heal. And I am praying and hoping for that. But I just don’t know.
Through this blog, I hope that you may be inspired, and that you may share in the joys that I am excited to embark on. As my first bucket-list item…or carpe diem item, as I prefer to call it, my dad and I are taking a spontaneous trip to NYC tomorrow!! I cannot wait!! :) Then there is Christmas and New years, and then its off to surgery for me. I will try my best to keep you all updated through this blog- I used to have a caring bridge (a website for patients that the parents would update), but my mom is tired and weary from all of this heart ache, so I am taking on the job.
I will write soon, my friends. I love all of you, from the bottom of my heart. Thank you for those of you who have been on this journey with me before. Its time for battle mode, once again.



September 21, 2012

By Laura

There are not a lot of words coming to mind right now about how to say what I am about to say. It is not anything I have ever been prepared for, and not something I think anyone is ever prepared for. I hate long and suspenseful intro’s- “beating around the bush”…so here it goes. The last three weeks- the hospital stays, the feeling horrible, etc.- has accumulated to us finding out that my cancer is still spreading. The last treatment, the samarium that I was given in Texas about 6 weeks ago, did not do what we were hoping it would do. My doctor out there called me one morning about a week ago while I was faking being asleep, leaving me a message to urgently call him back- and when I spoke with him, he gave me the bad news that they no longer have any options for me. The samarium was our last shot- because of my poor kidney function, I am not eligible for any other trials (trials require that your kidneys be in good condition for liability issues and blah blah). 5 years of chemo didn’t work, radiation didn’t work (to the extent we needed it to), angiogenesis didn’t work, internal radiation didn’t work… so here we are. We are having to make the devastating decision to stop treatment. The cancer is too aggressive and science is at a loss as to what to do. My body is so, so exhausted- and I am so, so exhausted.
It has been the hardest past few weeks of my entire life- harder than the month I was on high-dose ifosomide, when I was having seizures and laying basically unconscious for weeks at a time- even harder than when I was first diagnosed. I haven’t really distinguished whether or not knowing that my life is limited is a blessing or a curse… I am thankful that I have an opportunity to be able to tell people I love them and to reflect upon my life, but at the same time, I am crippled with anguish and fear. My emotions are shot, and my body is so fragile and weak- I hardly even recognize myself anymore. The tumors in my lungs are making it really hard to breath normally and fully, so I had to be put on at-home oxygen, and am basically on bed-rest all the time. I was officially admitted into hospice care on Wednesday. Basically being on hospice means I won’t have to go to the hospital at all anymore- the company we are using (ironically but divinely called “Journey Hospice”) can do everything a hospital can do at my house- even x-rays and CT’s and things ER’s can do. The only thing they can’t do is operate. So, I will be staying at home until… well, let’s not go there right now. But anyways, I’ve been really reluctant to post anything about any of this because quite frankly, thinking about it is extremely heart-wrenching for me. Prior to this post, only a select few knew what was going on…but for the sake of all those who have loved and cared for me over the years, I wanted to let you know what was going on.
There is nothing that I need or want. I know people want to help me somehow, but honestly I do not wish to receive any presents or money or anything like that (other than flowers if you are so inclined). My deepest wish is for people to pray for my friends and family… the thing that rips my heart up the most is knowing that my friends and family are in so much pain over losing me. If there is one thing I would ask for them, it would be that they have peace and that they would find joy. Everything that surrounds me emanates with the love from the people in my life- from the pictures on my wall to the clothes in my closet, and the little gifts and knick-knacks around my room from different experiences I have had. I am so incredibly blessed, and most of my tears come from basking in that realization. I have always known of these blessings, but I have never felt them so intimately until now.
All of this being said, I still believe that God has the power to heal me- even now. But, my heart is pretty sure that His healing is not going to be in a physical form. Even though this is not my ideal circumstance by any means, I have full confidence that I will be in Heaven, fully healed, fully restored, and fully new. The cancer WILL BE GONE. It may seem like cancer won, but it hasn’t and never will. God still has the victory, and I am humbled that He has chosen me to come be with Him. I am still filled with grief and fear over what is to come- but who wouldn’t be. That’s what makes me human I suppose. Thank you to all who have been there for me and who have followed my story- it is a story I know I was supposed to tell. I am not sure if I will be writing in here again- I only write when I feel led. But just know that my heart holds deep appreciation and love for all of you, and that my journey is not and will not ever be over.

with love,


Laura’s journey has just begun . . .

It is our duty to remember

Post Script:  

 Laura’s Blog was forwarded to Floyd & I so that we can share with everyone that [Laura’s] heart holds a deep appreciation and love for [everyone], and that [her] journey is not and will not ever be over.

 “We are all responsible for our wake and any influence it causes!”


"Leave a wake behind you, that you would want others to leave for you."

Til’ we chat again, Floyd & Joe

Tuesday, October 16, 2012

Chapter 31 Who Lives and Who Dies . . .

Chapter 31

      WHO KNEW . . .

“ The United States Rations HealthCare ”   

 Rationing HealthCare plays a major role

in Deciding . . . Who Lives and Who Dies . . .

Floyd, intuitively, is guided by the intrinsic belief that
 Humanity is defined by compassion for all people.
Therefore, Floyd has recently asked me

“Why does the United States government,
  many corporations and insurance agencies,
 Ration Health Care?

I was reluctant to answer, Floyd’s question during 

“National Breast Cancer Awareness Month”.

However, Floyd shared with me, two articles that she found on the internet

and encouraged me to change my mind.

I concluded that it is better to share her findings now, rather than later.

The first article, Floyd discovered was . . .

 From, the New York Times was written by:
Published: August 21, 2012
Older adults are understandably anxious about the political sniping over the future financing of Medicare. That is precisely the intention of the presidential campaigns.

Health care in the United States costs more than in almost any other country in the developed world, but quality is questioned.

Yet the cross-fire over who will cut Medicare by how much sidesteps a critical issue about the future of our medical care: If we must ration our care to hold down costs in the future, how can we do it in a fair, efficient and transparent way?

Mitt Romney’s campaign was brazenly misleading in its charge that the president’s health plan would cut medical services to older adults by reducing Medicare spending by $716 billion. The president’s savings will come mostly from smaller payments to managed care companies, which provide the same services as Medicare at a higher cost, and from slower growth in reimbursement rates to health care providers.

But the response of President Obama’s campaign also aimed to stoke voters’ fears. It stressed — rightly — that the plan to curb Medicare costs proposed last year by Representative Paul D. Ryan, Mr. Romney’s vice-presidential running mate, would add thousands of dollars to older Americans’ out-of-pocket expenditures. Yet it ignored Mr. Ryan’s recent efforts to soften the plan.

Both campaigns claim they are out to protect future health care. Yet the sniping hides the real issue. Protecting federal health programs over the long term, as the population ages and medical costs keep rising faster than economic growth, will require curbing the programs’ spending. And we haven’t quite figured out how to do that.

The federal government’s spending on health care consumes 4.8 percent of the nation’s economic production and is expected to eat up 9.2 percent in 25 years, according to estimates from the Congressional Budget Office. A vast majority of economists agree that restoring a sustainable budget will mean either cuts in Medicare and Medicaid or a tax increase on the middle class.

Decisions will have to be made about what services are not worth the cost. Yet so far, our political leaders have failed to acknowledge this to voters, offering instead an illusion that we can resolve the matter without any pain.

Recall the political firestorm in 2009 when the Preventive Services Task Force recommended that women start regular screening for breast cancer at age 50 rather than 40. “This is how rationing begins,” said Representative Marsha Blackburn, a Tennessee Republican. “This is when you start getting a bureaucrat between you and your physician.”

The task force is an independent panel of experts financed by the Department of Health and Human Services. Doctors and private insurers usually follow its recommendations. Still, in 2010 — after Mr. Obama’s health reform legislation passed Congress — the department said that insurers should ignore its latest findings and instead go back to its recommendation from 2002: that women start screening at 40.

Does it make sense that older adults in their last year of life consume more than a quarter of Medicare’s expenditures, costing more than six times as much as other beneficiaries? Are there limits to what Medicare should spend on a therapy prolonging someone’s life by a month or two?

It’s a tough political call. In light of the difficulties, our political leaders have preferred to punt on the issue, hoping it doesn’t have to be decided on their watch. Instead, when they talk about health care, they call rationing by some other name.

Rationing is inevitable in a world with finite resources. We do it in this country, too, and it is still one of the least fair and most inefficient rationing systems in the world. You get care if you have the money to pay for it; if not, you probably won’t.

The 30 percent of the population who are the heaviest users of health care account for nearly 89 percent of health care expenditures, according to a government study. But high-income Americans are more likely to see a doctor when they are sick, according to a study by the Organization for Economic Cooperation and Development. And the disparity between rich and poor is much higher than in other developed countries.

Meanwhile, tens of millions of Americans — those whose employers don’t provide health insurance, who are too poor to pay for it themselves and yet are too rich to use Medicaid — get the least health care of all.

A study of hospital emergency rooms in Wisconsin found that victims of severe traffic accidents without health insurance got 20 percent less care. Hospitals spent $3,300 more on average for each victim who was insured. They kept the insured 9.2 days, on average, and the uninsured just 6.4 days. Unsurprisingly, the uninsured were 40 percent more likely to die from their injuries.

Every health care proposal from the right and the left includes some form of implicit rationing device. Mr. Ryan’s plan, on the Republican side, would keep spending on Medicare under 4.75 percent of the nation’s output until 2050 by giving older adults born after 1958 a dollop of money to buy their own insurance, forcing many to choose cheaper plans or fewer procedures.

The president’s health care reform encourages rationing, too, by levying a tax on “Cadillac” insurance plans, and in turn pushing employers to seek cheaper options and lower costs. It creates an advisory board to cut costs from Medicare if spending rises above a set rate. And it finances an institute to evaluate which therapies are most clinically effective. Careful to avoid political blowback, the president’s plan forbids Medicare to base its reimbursement decisions on the institute’s findings.

But neither initiative seems likely to solve our health care financing squeeze over the long term. The cuts proposed by Mr. Ryan — shifting the risk of health care inflation onto the shoulders of older adults — are certainly drastic. They also seem politically unfeasible. Under Mr. Ryan’s most recent proposals, in 2030 Medicare would spend $2,200 less in today’s money on each new enrollee than under the most likely outcome envisioned by the Congressional Budget Office based on current policies. By 2050, it would pay $8,000 less. Voters seem to think that might be too drastic a cut.

The president’s plan was more about offering health insurance to all, to end our Dickensian system of rationing by income, than long-term cost control. Savings mandated by the Affordable Care Act over the next 10 years will be difficult to maintain beyond that.

It puts a lot of faith on eliminating waste, with potentially large savings. David Cutler, a health economist at Harvard, argues that a third of our health care dollars go to therapies that do not improve our health. A lot of that waste could be slashed simply by no longer paying providers a fee for each service, whether we need it or not, and paying them instead to keep us healthy.

Going after waste seems sensible in a health care system that costs more than almost any other in the developed world, yet delivers lower-quality care. But savings from waste tend to be hard to achieve. Even with the Affordable Care Act in place, federal health spending will eat up almost twice as much of this nation’s economic product in 2037 as it does today, according to the budget office.

While it is reasonable for politicians to shy away from rationing — especially when voters believe no expense should be spared to save a human life — if the experience of other countries serves as precedent, they will probably get there sooner or later. In Britain, the National Institute for Health and Clinical Excellence determines what therapies will be covered by the National Health Service. It generally recommends against paying for a therapy that costs more than $31,000 to $47,000 for each year of life gained, adjusted for quality.

Putting a value on life, as it were, is controversial. The National Institute in Britain has denied or limited coverage of expensive drugs for ailments like pancreatic cancer, macular degeneration and Alzheimer’s. But in a world of limited budgets, such decisions must be made.

Similar systems exist in many countries, including Australia and New Zealand, where the government decided not to pay for a universal vaccine against pneumococcal disease until its price fell to 25,000 New Zealand dollars (about $20,000) per quality-adjusted life year.

Though this concept may sound foreign, Washington has been putting a price on life since the administration of Ronald Reagan — who determined that regulations should pass through a strict cost-benefit analysis, with values placed on factors like life and health. The Environmental Protection Agency values a life at about $9 million today. In 2009, the Transportation Department used a price tag of about $6 million. If safety improvements on a road were projected to cost more than the value of the lives expected to be saved by the improvement, the project would be deemed too expensive.

This approach has been contentious. And it has had an impact on Americans’ health. In 1991 an appeals court reversed the E.P.A.’s decision to ban asbestos on the ground that it was too costly. The E.P.A., it argued, “would have this court believe that Congress, when it enacted its requirement that the E.P.A. consider the economic impacts of its regulations, thought that spending $200 million to $300 million to save approximately seven lives (approximately $30 million to $40 million per life) over 13 years is reasonable.” The court disagreed.

Medicare could well be forced, one day, to make similar evaluations.

This article has been revised to reflect the following correction:
Correction: August 23, 2012

The Economic Scene column on Wednesday, about finding a fairer way to ration health care in the United States, misstated the results of a government study on health care expenditures. The study, by the Department of Health and Human Services’ Agency for Healthcare Research and Quality, found that 89 percent of health care expenditures were accounted for by the 30 percent of Americans who use health care most heavily, not by the wealthiest 30 percent.
The second article . . . she discovered was . . .

Shortchanging Cancer Patients

Also from the New York Times was written by:
Published: August 6, 2011
RIGHT now cancer care is being rationed in the United States.

Probably to their great disappointment, President Obama’s critics cannot blame this rationing on death panels or health care reform. Rather, it is caused by a severe shortage of important cancer drugs.

Of the 34 generic cancer drugs on the market, as of this month, 14 were in short supply. They include drugs that are the mainstay of treatment regimens used to cure leukemia, lymphoma and testicular cancer. As Dr. Michael Link, the president of the American Society of Clinical Oncology, recently told me, “If you are a pediatric oncologist, you know how to cure 70 to 80 percent of patients. But without these drugs you are out of business.”

This shortage is even inhibiting research studies that can lead to higher cure rates: enrollment of patients in many clinical trials has been delayed or stopped because the drugs that are in short supply make up the standard regimens to which new treatments are added or compared.

The sad fact is, there are plenty of newer brand-name cancer drugs that do not cure anyone, but just extend life for a few months, at costs of up to $90,000 per patient. Only the older but curative cancer drugs — drugs that can cost as little as $3 per dose — have become unavailable. Most of these drugs have no substitutes, but, crazy as it seems, in some cases these shortages are forcing doctors to use brand-name drugs at more than 100 times the cost.

Only about 10 percent of the shortages can be attributed to a lack of raw materials and essential ingredients to manufacture the drugs. Most shortages appear instead to be the consequence of corporate decisions to cease production, or interruptions in production caused by money or quality problems, which manufacturers do not appear to be in a rush to fix.

If the laws of supply and demand were working properly, a drug shortage would cause a price rise that would induce other manufacturers to fill the gap. But such laws do not really apply to cancer drugs.
The underlying reason for this is that cancer patients do not buy chemotherapy drugs from their local pharmacies the way they buy asthma inhalers or insulin. Instead, it is their oncologists who buy the drugs, administer them and then bill Medicare and insurance companies for the costs.

Historically, this “buy and bill” system was quite lucrative; drug companies charged Medicare and insurance companies inflated, essentially made-up “average wholesale prices.” The Medicare Prescription Drug, Improvement and Modernization Act of 2003, signed by President George W. Bush, put an end to this arrangement. It required Medicare to pay the physicians who prescribed the drugs based on a drug’s actual average selling price, plus 6 percent for handling. And indirectly — because of the time it takes drug companies to compile actual sales data and the government to revise the average selling price — it restricted the price from increasing by more than 6 percent every six months.

The act had an unintended consequence. In the first two or three years after a cancer drug goes generic, its price can drop by as much as 90 percent as manufacturers compete for market share. But if a shortage develops, the drug’s price should be able to increase again to attract more manufacturers. Because the 2003 act effectively limits drug price increases, it prevents this from happening. The low profit margins mean that manufacturers face a hard choice: lose money producing a lifesaving drug or switch limited production capacity to a more lucrative drug.

The result is clear: in 2004 there were 58 new drug shortages, but by 2010 the number had steadily increased to 211. (These numbers include noncancer drugs as well. )

Unfortunately, there is no quick fix, because all solutions require legislation. A bill introduced in February by Senator Amy Klobuchar, Democrat of Minnesota, and Senator Bob Casey, Democrat of Pennsylvania, would require generic manufacturers to notify the Food and Drug Administration if they expected a supply problem or planned to stop manufacturing a drug. But the F.D.A. isn’t able to force manufacturers to produce a drug, and learning about impending shortages with little authority to alleviate them is of limited benefit. Indeed, early warning could exacerbate the problem: the moment oncologists or cancer centers hear there is going to be a shortage of a critical drug, their response could well be to start hoarding.

You don’t have to be a cynical capitalist to see that the long-term solution is to make the production of generic cancer drugs more profitable. Most of Europe, where brand-name drugs are cheaper than in the United States, while generics are slightly more expensive, has no shortage of these cancer drugs.

One solution would be to amend the 2003 act to increase the amount Medicare pays for generic cancer drugs to the average selling price plus, say, 30 percent, after the drugs have been generic for three years. This would encourage the initial rapid price drop that makes generics affordable, but would allow for an increase in price and profits to attract more generic producers and the fixing of any manufacturing problems that subsequently arose.

Increasing the price for generic oncology drugs would have a negligible impact on overall health care costs. Total spending on generic injectable cancer drugs was $400 million last year — just 2 percent of cancer drug costs, and less than 0.5 percent of the total cost of cancer care. If we are worried about costs, we could follow Europe and pay for the higher prices by lowering what Medicare pays for the brand-name drugs that extend life by only a few months.

A more radical approach would be to take Medicare out of the generic cancer drug business entirely. Once a drug becomes generic, Medicare should stop paying, and it should be covered by a private pharmacy plan.

 That way prices can better reflect the market, and market incentives can work to prevent shortages.
Scare-mongering about death panels and health care reform has diverted attention from real issues in our health care system. Shortages in curative cancer treatments are completely unacceptable. We need to stop the political demagoguery and fix the real rationing problem.

In addition to these two articles,

Floyd wanted our readers to become familiar with

 what Wikipedia had available on this topic;

Healthcare rationing in the United States

From Wikipedia, the free encyclopedia

Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes insurance companies pre-screen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions.[1][2][3] 

Access to state Medicaid programs is restricted by income and asset limits via a means-test, and to other federal and state eligibility regulations. Health maintenance organizations (HMOs) that commonly cover the bulk of the population, restrict access to treatment via financial and clinical access limits.[4]

The Patient Protection and Affordable Care Act passed in March 2010 will prohibit insurers from limiting coverage to people with preexisting conditions beginning in 2014, which will alleviate this type of rationing.
Some in the media and academia have advocated rationing of care to limit the overall costs in the U.S. Medicare and Medicaid programs, arguing that a proper rationing mechanism is more equitable and cost-effective.[5][6][7] The Congressional Budget Office (CBO) has argued that healthcare costs are the primary driver of government spending over the long-term.[8]

Types of rationing

[edit] Rationing by Insurance companies

President Obama has noted that U.S. healthcare is rationed based on income, type of employment, and pre-existing medical conditions, with nearly 46 million uninsured. He states that millions of Americans are denied coverage or face higher premiums as a result of pre-existing medical conditions.[1]

In an e-mail to Obama supporters, David Axelrod wrote: "Reform will stop 'rationing' - not increase it.... It’s a myth that reform will mean a 'government takeover' of health care or lead to 'rationing.' To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies."[11]
A 2008 study by researchers at the Urban Institute found that health spending for uninsured non-elderly Americans is only about 43% of health spending for similar, privately insured Americans. These data imply rationing by price and ability to pay.[12]

Fareed Zakaria wrote that only 38% of small businesses provide health insurance for their employees during 2009, versus 61% in 1993, due to rising costs.[13]

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period. It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.[14]

Private and public insurers all have their own drug formularies through which they set coverage limitations which may include referral to the insurance company for a decision as to whether the company will or will not approve its share of the costs. American formularies make generalized coverage decisions by class with cheaper drugs in classes at one end of the scale and expensive drugs with more conditions for referral and possible denial at the other.[15] Not all drugs may be in the formulary of every company and consumers are advised to check the formulary before deciding to buy insurance.[16]

The phenomena known as medical bankruptcy is unheard of in countries with universal health care in which medical copays are low. In the United States however, research shows that many bankruptcies have a strong medical component and that many of those who go bankrupt for a medical reason did have medical insurance. Medical insurance in the United States prior to the Affordable Care Act allowed annual caps or lifetime caps on coverage and, due to the high cost of care in the United States, it was not uncommon for the insured to suffer bankruptcy due to breaching these limits.

[edit] Rationing by price

A July 2009 NPR article quoted various doctors describing how America rations healthcare. Dr. Arthur Kellermann said: "In America, we strictly ration health care. We've done it for years...But in contrast to other wealthy countries, we don't ration medical care on the basis of need or anticipated benefit. In this country, we mainly ration on the ability to pay. And that is especially evident when you examine the plight of the uninsured in the United States."[17]

Rationing by price means accepting that there is no triage according to need. Thus in the private sector it is accepted that some people get expensive surgeries such as liver transplants or non life threatening ones such as cosmetic surgery, when others fail to get cheaper and much more cost effective care such as prenatal care, which could save the lives of many fetuses and newborn children. Some places, like Oregon for example, do explicitly ration Medicaid resources using medical priorities.[18]

Polling has discovered that Americans are much more likely than Europeans or Canadians to forgo necessary health care (e.g. not seeking a prescribed medicine) on the grounds of cost.

[edit] Rationing by pharmaceutical companies

Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits applied by regulators. American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That is rationing based on ability to pay.[1]

[edit] Rationing through government control

Republican Newt Gingrich argued that the reform plans supported by President Obama expand the control of government over healthcare decisions, which he referred to as a type of healthcare rationing. He expressed concern that, although there is nothing in the proposed laws that would constitute rationing, the combination of the following three factors would increase pressure on the government to ration care explicitly for the elderly:[19] An expanded federal bureaucracy, the pending insolvency of Medicare within a decade, and the fact that 25% of Medicare costs are incurred in the final year of life.

Princeton Professor Uwe Reinhardt wrote that both public and private healthcare programs can ration, rebutting the concept that governments alone impose rationing: "Many critics of the current health reform efforts would have us believe that only governments ration things.... On the other hand, these same people believe that when, for similar reasons, a private health insurer refuses to pay for a particular procedure or has a price-tiered formulary for drugs – e.g., asking the insured to pay a 35 percent coinsurance rate on highly expensive biologic specialty drugs that effectively put that drug out of the patient’s reach — the insurer is not rationing health care. Instead, the insurer is merely allowing “consumers” (formerly “patients”) to use their discretion on how to use their own money. The insurers are said to be managing prudently and efficiently, forcing patients to trade off the benefits of health care against their other budget priorities."[20]

During 2009, former Alaska Governor Sarah Palin wrote against rationing by government entities, referring to what she interpreted as such an entity in current reform legislation as a "death panel" and "downright evil." Defenders of the plan indicated that the proposed legislation H.R. 3200 would allow Medicare for the first time to cover patient-doctor consultations about end-of-life planning, including discussions about drawing up a living will or planning hospice treatment. Patients could seek out such advice on their own, but would not be required to. The provision would limit Medicare coverage to one consultation every five years.[21] However, Palin also had supported such end of life counseling and advance directives from patients during 2008.[22]

Ezra Klein described in the Washington Post how polls indicate senior citizens are increasingly resistant to healthcare reform, due to concerns about cuts to the existing Medicare program that may be required to fund it. This is creating an unusual and potent political alliance, with Republicans arguing to protect the existing Medicare program, despite its position as one of the major entitlement programs they historically have opposed.[23] The CBO scoring of the proposed America's Affordable Health Choices Act of 2009 (also called HR3200) includes $219 billion in savings over 10 years, some of which would come from Medicare changes.[24]

[edit] Arguments for enhancing rationing processes

Peter Singer argued for enhancing the rationing processes:[1]
"Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?"

[edit] Rationing based on economic value added

A concept called "quality-adjusted life year" (QUALY) is used to measure the cost-benefit of applying a particular medical procedure. It reflects the quality and quantity of life added due to incurring a particular medical expense. The measure has been used for over 30 years and is implemented in several countries to help with rationing decisions. Australia applies QUALY measures for its form of Medicare to control costs and ration care, while allowing private supplemental insurance.[25]

[edit] Rationing using comparative effectiveness research

Medicare spending per person varied significantly across states in 2006
Several treatment alternatives may be available for a given medical condition, with significantly different costs yet no statistical difference in outcome. Such scenarios offer the opportunity to maintain or improve the quality of care, while significantly reducing costs, through comparative effectiveness research. Writing in the New York Times, David Leonhardt described how the cost of treating the most common form of early-stage, slow-growing prostate cancer ranges from an average of $2,400 (watchful waiting to see if the condition deteriorates) to as high as $100,000 (radiation beam therapy):[26]

Some doctors swear by one treatment, others by another. But no one really knows which is best. Rigorous research has been scant. Above all, no serious study has found that the high-technology treatments do better at keeping men healthy and alive. Most die of something else before prostate cancer becomes a problem.
According to economist Peter A. Diamond and research cited by the Congressional Budget Office (CBO), the cost of healthcare per person in the U.S. also varies significantly by geography and medical center, with little or no statistical difference in outcome.[27]

Although the Mayo Clinic scores above the other two [in terms of quality of outcome], its cost per beneficiary for Medicare clients in the last six months of life ($26,330) is nearly half that at the UCLA Medical Center ($50,522) and significantly lower than the cost at Massachusetts General Hospital ($40,181)...The American taxpayer is financing these large differences in costs, but we have little evidence of what benefit we receive in exchange.

Comparative effectiveness research has shown that significant cost reductions are possible. Office of Management and Budget (OMB) Director Peter Orszag stated: "Nearly thirty percent of Medicare's costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level of low-cost areas."[28]

President Obama has provided more than $1 billion in the 2009 stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. Economist Martin Feldstein wrote in the Wall Street Journal that "Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost."[29]

[edit] Rationing as part of fiscal discipline

Former Republican Secretary of Commerce Peter G. Peterson indicated that some form of rationing is inevitable and desirable considering the state of U.S. finances and the trillions of dollars of unfunded Medicare liabilities. He estimated that 25-33% of healthcare services are provided to those in the last months or year of life and advocated restrictions in cases where quality of life cannot be improved. He also recommended that a budget be established for government healthcare expenses, through establishing spending caps and pay-as-you-go rules that require tax increases for any incremental spending. He has indicated that a combination of tax increases and spending cuts will be required. He advocated addressing these issues under the aegis of a fiscal reform commission.[6]

Arizona recently modified its Medicaid coverage rules because of a budget problem which included denying care for expensive treatments such as organ transplants to Medicaid recipients, including those who had previously been promised funding.[30] MSNBC's Keith Olbermann and others have dubbed Governor Jan Brewer and the state legislatures as a real life death panel because many of those poor people who are now being denied funding will lose their lives or have a worsened outlook as a result of this political decision.

[edit] Old-age-based health care rationing

In America, the discussion on rationing health care for the elderly began to take root in 1983 when economist Alan Greenspan asked "whether it is worth it", referring to the use of 30% of the Medicare budget on 5 to 6 percent of those eligible who then die within a year of receiving treatment. In 1984 then Democrat governor of Colorado Richard Lamm was widely quoted (though he argues he was mis-quoted) as saying the elderly "have a duty to die and get out of the way."[31] Medical ethicist Daniel Callahan's 1987 Setting Limits: Medical Goals in an Aging Society[32] discusses whether health care should be rationed by age. In Callahan's view old people are "a new social threat" whom he considers selfish and his remedy for this threat is to use age as a criterion in limiting health care. Callahan's book has been widely discussed in the America media including the New York Times, the Washington Post, the Wall Street Journal and in "just about every relevant professional and scholarly journal and newsletter."[33] One of the major arguments against such age-based rationing is the fact that chronological age by itself is a poor indicator of health.[34] Another major argument against Callahan's proposal is that it inverts the Western tradition by making death a possible good and life a possible evil, which means, according to Amherst College Jurisprudence professor Robert Laurence Barry, that Callahan's view amounts to "medical totalitarianism".[35] One book-length rebuttal to Callahan's views from a half dozen professors who held a conference at the University of Illinois College of Law in October 1989 can be found in 1991's Set No Limits: a Rebuttal to Daniel Callahan's Proposal to Limit Health Care edited by Robert Laurence Barry and Religious studies University of Illinois at Urbana-Champaign visiting professor Gerard V. Bradley.[35]

[edit] Consequences of not controlling healthcare costs

Medicare and Medicaid Spending as % GDP

The Congressional Budget Office reported in June 2008 that:[8]
"Future growth in spending per beneficiary for Medicare and Medicaid—the federal government’s major health care programs—will be the most important determinant of long-term trends in federal spending. Changing those programs in ways that reduce the growth of costs—which will be difficult, in part because of the complexity of health policy choices—is ultimately the nation’s central long-term challenge in setting federal fiscal federal Medicare and Medicaid outlays will rise from 4 percent of GDP in 2007 to 12 percent in 2050 and 19 percent in 2082—which, as a share of the economy, is roughly equivalent to the total amount that the federal government spends today. The bulk of that projected increase in health care spending reflects higher costs per beneficiary rather than an increase in the number of beneficiaries associated with an aging population."

In other words, all other federal spending categories (e.g., Social Security, Defense, Education, and Transportation) would require borrowing to be funded, which is not feasible.

President Obama stated in May 2009: "But we know that our families, our economy, and our nation itself will not succeed in the 21st century if we continue to be held down by the weight of rapidly rising health care costs and a broken health care system...Our businesses will not be able to compete; our families will not be able to save or spend; our budgets will remain unsustainable unless we get health care costs under control."[36]

 Consequences of
Controlling healthcare access
" Some live and many die "

Those that vote, get to Decide . . .

Do we want to ensure that healthcare is available To “ALL”, Regardless, of one’s ability 2 Pay2 Survive . . . Or not ?

Floyd & I believe, that we should afford everyone with 

equal access to healthcare . . . to Live, In dignity,

from all infirmities within our reach.

Floyd cannot vote to change policy . . .

But, you & I can . . .

Where do you Stand ?

until you decide . . .

 many still die

 “We are all responsible for our wake and any influence it causes!”

So Please,

"Leave a wake behind you, that you would want others to leave for you."

Post Script:

Everyone does not have access to the internet,

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with others . . . 

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Til’ we chat again, 

Floyd & Joe