Health Care & Poverty

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Steve
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Post by Steve »

Here I am again, just to toss in a couple more cents:
Ian: i will say, i'm not impressed by the story about the alcoholic man. ok, so he drinks a lot. what does that have to do with his being a "poor person?" you think poor people are the only people who drink a lot?
Considering the fact that he couldn't afford an albuterol prescription, though it's available through Wal-Mart's $4 prescription program, says to me he's probably not rolling in money. Yet he finds a way to buy alcohol (often much more expensive than $4). As a result, he winds up costing everyone else a fortune. I think this might be an issue of poor money management (and addiction?) rather than straight-up poverty--those who abuse the health care system while freely using what income they have on other selfish pursuits (which often get them in the sticky predicament in the first place).

Anyway, just another sidenote brought to you in part by Steve.
When God can do what he will with a man, the man may do what he will with the world.     ~George MacDonald
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Post by Ian »

it's very difficult to pinpoint the causes of illness. should we be making moral judgments about someone's individual culpability for their illness? if someone is sick, and you tell them that they are to blame for that sickness, you're basically saying that they deserve to be sick. think what it would be like to say that to someone's face.

is steve trying to say that alcoholics are to blame for our health care woes? i think it's incredibly self-righteous to call the purchase of alcohol a "selfish pursuit."

does the alcoholic not deserve health care? what point are you guys trying to make with this alcoholic story?
so let it be written... so let it be done.
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Post by Steve »

it's very difficult to pinpoint the causes of illness.
Thus saith the lawyer. :)
should we be making moral judgments about someone's individual culpability for their illness?
Sure, if it can help them prevent future occurrences. Why treat the symptoms when you can help treat the cause?
if someone is sick, and you tell them that they are to blame for that sickness, you're basically saying that they deserve to be sick. think what it would be like to say that to someone's face.
My mom used to say it all the time when I didn't wear my coat to school. I don't blame her.
is steve trying to say that alcoholics are to blame for our health care woes? i think it's incredibly self-righteous to call the purchase of alcohol a "selfish pursuit."
Self-righteous? What? So you'd call the purchase of alcohol an "unselfish pursuit?" What benefit does it give humanity, Ian? (And also, why do you address me in the 3rd person whenever we have these discussions? hehe)
does the alcoholic not deserve health care? what point are you guys trying to make with this alcoholic story?
I'm not quite sure I understand your reasoning for immediately jumping to the alcoholic's defense. Addiction is tough; I don't claim that escaping alcoholism would be an easy task. However, that doesn't mean I continue to dump money/time/resources on someone who chooses to engage in behavior that endangers themselves instead of those who did not choose their predicament. We can help both, but if I had to choose who to put in the last ER bed, I'd probably choose the person who wasn't repeatedly engaging in risky behavior through their own actions. And regarding the alcoholic, I think I'd focus on treating the alcoholism rather than repeatedly treating the resulting illnesses.

"You've got a stake in your chest...here, let me wipe away that blood and give you some painkillers."
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Edward
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Post by Edward »

But Steve, you can't honestly say that if an alcoholic comes in with a failing liver, you would tell him "we're not going to treat you, but rather let's talk about kicking this habit. Have a seat, Joe." He's SICK--he NEEDS HELP! Of course we should be preventing the problems, but when a problem strikes that's when you drop everything and HELP THE MAN.
Why treat the symptoms when you can treat the cause?
Because he's laying on a stretcher dying! Who cares what got him there, you've got to help him! Helping people is, at its heart, an act of charity. How can we say "I'm not gonna waste my time and money on somebody that's ruining their life." Those are the people that need it most! We should put our efforts into helping them, not just preventing the problem, but treating it, and nurturing the person. Why are we so upset about money being spent on these people? Shouldn't it used to help them? Are we angry when out money is used on an alcoholic rather than some little kid? In the Lord's eyes, what's the difference? Aren't they equally important to him? Can we say one deserves help more than another?
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Post by Steve »

Edward, your trouble is that you assume there are unlimited resources available that magically appear to be able to perfectly heal every soul on earth. If that were the case, would there even be an issue with health care in the U.S.? Couldn't everyone just walk in and get whatever care they needed?

The whole debate centers around limited resources, does it not? Do you honestly think the crisis stems around a doctor's unwillingness to help people in need? Your approach is very kind, but it's not reasonable.

And you're also assuming that health care revolves around a midnight run to the ER. Health care issues don't begin with a single patient's urgent trip to the ER. They begin long before that.
Are we angry when out money is used on an alcoholic rather than some little kid? In the Lord's eyes, what's the difference? Aren't they equally important to him? Can we say one deserves help more than another?
Your neighbor's son punches your son in the face and starts complaining of sore knuckles. Who do you treat first?
When God can do what he will with a man, the man may do what he will with the world.     ~George MacDonald
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Post by Edward »

Your neighbor's son punches your son in the face and starts complaining of sore knuckles. Who do you treat first?
Is this a race to see who gets treated first? Is there some poor sweet Grandma racing to beat the druggie to the ER? It's not a matter of who gets there first, it's "how can we help everybody?" Like you said, it's about making the money work--not beating the clock. But these aren't just "sore knuckles" we're dealing with; that's a callous way to look at somebody who's vitals are failing, I don't care how it happened. Yes we want to treat the issues of addiction and all that, but when it gets down to people in immediate need, they need help. If they need a prescription they need a prescription. It's not a matter of being able to afford a car or not, it's a matter of keeping people alive and healthy. That's just the problem--people can't just walk in and get whatever care they need. That is what needs to be solved.
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Post by Steve »

It's not so much a race as it is simply an allocation of limited resources.
But these aren't just "sore knuckles" we're dealing with; that's a callous way to look at somebody who's vitals are failing, I don't care how it happened.
So then we're not talking about health care overall...we're just talking about urgent care. Well that's only a tiny piece of the puzzle. Immediate needs aren't really the controversy in my opinion.
it's a matter of keeping people alive and healthy.
And much of keeping people alive and healthy has to do with allocation of limited resources. It's looking at the big picture and seeing what needs to be addressed for the betterment of society's health, not tending to individual cases with no questions asked. That's distributing a lot of fish while leaving the fishing-poles leaning against the wall. That is what needs to be solved. ;)
When God can do what he will with a man, the man may do what he will with the world.     ~George MacDonald
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Post by Edward »

That's distributing a lot of fish while leaving the fishing-poles leaning against the wall. That is what needs to be solved. ;)
Huh? :confused:
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Post by Ian »

on the one hand, people say that we should provide medical care to the poor. but on the other hand, those same people resent "dumping" money on people (such as the poverty-stricken and/or alcohol-addicted) who are engaged in "risky" behavior. don't you see how uncharitable it is to discriminate between so-called deserving sick people and undeserving sick people? steve brings up finite resources. are wealthy people being turned away from hospitals? are doctors not getting paid? besides, you simply can't determine the level of responsibility that an individual has to their sickness. is edward the only voice of reason here?
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Post by Steve »

Still can't shake that 3rd person...ah well. ;)
is edward the only voice of reason here?
If by "voice of reason" you mean the only voice, Ian, that supports your views, then yes, I suppose he is.

Look at me, here I am starting to jump into the foray. I don't entirely know where I stand on the issue of health care, and I certainly don't have the answer per se, but the things I've said are valid I think. It's easy to take the high road when you're not the one paving it.

Let's take this a step at a time, since you're disagreeing without providing any perspective:
1) Are resources finite, Ian, or aren't they? And I don't just mean money. You mock the notion that they are finite, so I assume you believe them to be unlimited?
2) You say that one cannot determine the level of responsibility an individual has to their sickness. Is that a fact?
3) You believe that every available resource should be expended on every available person at every available moment, no questions asked? How does our country go about accomplishing this? And this will solve our health care problems?
4) Do you honestly think I have a vendetta against poor people, Ian? I mean, come on... Do you think any of us do?

And finally, do you even care to discuss these things anyway? You rarely answer my questions...you just drop another blanket statement about how awful (and utterly void of reason) we are. That's probably not the most persuasive tactic. I'd suggest a return to the fundamentals of discussion, which includes both listening and responding in turn to what others say. Just a thought.
When God can do what he will with a man, the man may do what he will with the world.     ~George MacDonald
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Post by Edward »

1) Are resources finite, Ian, or aren't they? And I don't just mean money. You mock the notion that they are finite, so I assume you believe them to be unlimited?
They aren't nearly as limited as people make them out to be, but all people can think about is "what will this cost me in tax dollars?" They always look at it through personal loss rather than through the need at hand. Of course they are finite, but should that make the care we offer finite too? Is there a limit to the level we should go to help people? "Sorry dying druggie, but you've gone too far. We're gonna let you die because of your risky behavior." Can we actually bring ourselves to do that? Finite resources cannot justify finite medical care and attention, not just urgent care, but yes, even prescriptions, check ups, and help.
2) You say that one cannot determine the level of responsibility an individual has to their sickness. Is that a fact?
Frankly, it doesn't make a ding-dong difference whether the person is responsible or not. If they need help they should get it. If it's hard, it's still necessary. If they're a person then they should get help. Is that so hard to grasp? Is that level of compassion so hard to realize?
3) You believe that every available resource should be expended on every available person at every available moment, no questions asked? How does our country go about accomplishing this? And this will solve our health care problems?
A fair question, but they have to be divided. YES, every resource should be expended on every person at any moment, no questions asked--if they need it they should get it. That is a solid principle.
How? That is a more reasonable question, and that seems to be the crux of your position. I don't know how, and I want to know, but that cannot be tied to the issue of who gets help or who deserves it. The fact that it is a challenging issue DOES NOT ALTER the fact that they should get help. The how of "how do we help them" has no place in the what--that they need help. We've got to give it to them.
4) Do you honestly think I have a vendetta against poor people, Ian? I mean, come on... Do you think any of us do?
We know you're no monster, but there is so much that is not being recognized, especially when we use that label "poor people." It's so vast a term, and the majority of them are good people. We speak of them like they're the refuse of society sometimes.
And finally, do you even care to discuss these things anyway? You rarely answer my questions...you just drop another blanket statement about how awful (and utterly void of reason) we are.
Who is this we? Those on your "side" of the issue?
That's probably not the most persuasive tactic. I'd suggest a return to the fundamentals of discussion, which includes both listening and responding in turn to what others say. Just a thought.
It's not a matter of persuasion, it's a matter of making matters clear. You can feel as you will, but for my part this isn't just nice feelings and kind wishes. It's a matter of how things are and need to be. More important than the "fundamentals of discussion" (a great book title by the way) is making issues clear so that they can be understood. Sometimes those "fundamentals" impede our capacity to assert ourselves. We've got to be forthright if we want to make a change.
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Post by Angela »

After my own research and much thought about the subject I wholly agree with Ian and Edward. Everyone deserves and should be given proper medical care regardless of what color their skin is, how much money they make, how sick they are, what gender they are, and whatever addiction they may have. Edward made a good point when he said that "In the Lord's eyes, what's the difference?" What does it matter to you personally whether or not some random drug addict gets medical attention or not. If he does receive proper care, does this upset you in any way? If it does because it "drains the economy" or whatever then maybe you shouldn't pay your taxes, ya' know because it's just going to be wasted on some drunkard or meth addict.
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Post by Ann »

Actually, Ian, yours and Edward's arguments show how much you really don't know what the issues are in health care. You really aren't listening to anyone but yourself and Edward (with whom it seems you agree). I can't believe you still maintain that we discriminate against poor people. Even if you didn't listen to Bryn and I, at least you could have listened to Dad when he talked about the frustration due to those who take advantage of the weaknesses and loopholes in the system (whatever their socioeconomic status). Yes, Steve is correct in that there are finite resources. Many people (rich, poor, whatever), at least in the Salt Lake Valley, are literally turned away from the hospitals because there aren't enough beds. This happens at the University Hospital, Primary Childrens,' the VA, etc. This really happened quite frequently when I was on-call overnight. Often the hospitals all over the valley are full by the evening, so it ends up being a pretty quiet call night since we can't take on any more patients. Perhaps it's better now that the new IMA hospital is open. It's pretty lame to see someone who is admitted because she appears (and of course you'll jump all over this to hear me say "appears") to be writhing in pain from her knee despite a negative workup which revealed no true pathology in her knee, and see someone else in heart failure turned away from being admitted to the hospital because there are no beds. I'm not saying that it was just her fault - she put on the show (there's more to the story than this but we don't necessarily have to go over all the details) and the ER doc believed her and admitted her for the workup. You don't die from knee pain (unless you have septic arthritis, which she didn't have), but people die all the time from heart failure.
You can determine the level of responsibility - it is called determining a patient's competence - it can only be determined by a judge. In the hospital setting, you can legally determine a patient's capacity for decision making. Of course, it's not perfect, but as medicine is tending towards having patients be responsible for their own medical decisions, provided that they are given reasonable information, somebody has determined that patients should be competent and have the capacity for making their own decisions and be held to their decisions.
Last edited by Ann on Fri Dec 21, 2007 1:40 am, edited 1 time in total.
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Post by Ann »

Angela and I were typing our posts at the same time in the same room and her post beat mine by 3 min :D . I guess I already addressed what Angela talked about and Edward's point that Angela quoted. I think we're all in agreement that everyone should be treated the same, despite what others are telling me that I believe. I have never stated that I give different care to people based on race, socioeconomic status, etc. I feel like we're beating a dead horse or something. I'm going to bed!
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Post by Edward »

That's what I can't understand--somebody is suffering from heart failure and they turn them away? How can that happen? Yet we criticize other patients for being there in the first place. If those rejected people die, are you really going to blame it on the other patients for being there? Sure there are people everywhere who are filling up the facilities, but do we really feel that they all want to be in the hospital? Somehow there's go to be a way to help them even if there aren't any beds--but to blame the other patients in the hospital just isn't reasonable, nor is it fair, and to determine who "deserves to be there" or not seems very cold and officious when we're dealing with real people. Yet that's part of the issue--these are people, not just patients.

Nobody deserves to be in the hospital--yet when some druggie gets sick, we say it's his fault, yet this person who "deserves" to be sick shouldn't be taking space from some nice lady who doesn't deserve to be sick, yet does deserve the care that the addict is too trashy for? How does this make sense? Yet that's the cycle that's being perpetuated all the time.
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