[ExI] H+ Healthcare

[Mirco Romanato]

natasha at natasha.cc ha scritto:
> 
> Today my 91 year old mother is having cataract surgery.  It is not a
>  simple procedure because she should have had this surgery done 6 or 
> more years ago.  Her former eye doctor never told her how bad it had 
> gotten because of her elderly age. He assumed that she is too old for
>  surgery. However, her current doctor recognizes my mother?s vibrant,
>  youthful attitude and is performing the surgery.
> 
> I bring this up because if we have a universal healthcare, how will 
> elderly people be handled? Will they be considered too old to repair?
> 
> 
Maybe.
This usually depend on how the incentives are set and the system is built.
The surgery could be done too much or not enough.
If the Health Service will pay too much for a procedure, there is the
incentive to do it more than needed; if it pay not enough, there is the
incentive to do something other. Usually it will too much for some and
not enough for other in the same time.

For example, remembering that people is innocent until proven guilty,
there is this case:
http://milano.repubblica.it/dettaglio/clinica-degli-orrori-disposti-nuovi-arresti-omicidio-aggravato-dalla-crudelta/1632625
>> It extends the list of accusations against the doctors of the 
>> Department of Thoracic Surgery of the Santa Rita Clinic in Milan, 
>> now City Clinic study, travolta dall'ondata of arrests in June of 
>> last year. I militari della guardia di finanza hanno notificato una
>>  nuova ordinanza di custodia cautelare in carcere all'ex primario 
>> del reparto, Pier Paolo Brega Massone, e al suo vice Pietro Fabio 
>> Presicci (già detenuti nell'ambito dell'inchiesta) e hanno 
>> riportato in carcere un altro componente dell'équipe chirurgica, 
>> Marco Pansera, che si trovava ai domiciliari. The military guard of
>>  Finance have issued a new order for custody in the prison ward of 
>> the former primary, Pier Paolo Brega Massone, and his deputy Peter 
>> Fabio Presicce (formerly detained in the investigation) and have 
>> reported to prison another surgical team members, Mark Panseri, who
>>  was standing on the home.
>> 
>> L'accusa per loro è di omicidio volontario aggravato dalla crudeltà
>>  per aver eseguito operazioni inutili e ottenere così indebiti 
>> rimborsi dal sistema sanitario nazionale. The charge for them is to
>>  murder aggravated by cruelty for having performed unnecessary 
>> operations and thus obtain unwarranted reimbursements from national
>>  health system. Interventi che in quattro casi, stando a una nuova 
>> consulenza della procura, avrebbero causato la morte dei pazienti. 
>> Interventions in four cases, according to a new advice of the 
>> Prosecutor, would have caused the death of patients. Tre di questi 
>> episodi non avevano retto al tribunale del tiesame, che in 
>> relazione all'omicidio aveva annullato l'ordinanza di custodia 
>> cautelare in carcere, confermandola, invece, per altri reati. Three
>>  of these episodes did not court the right to tiešam, in relation
>> to murder that had canceled the order for remand in prison, 
>> confirming, however, for other crimes.
>> 
>> Dalla nuova consulenza disposta dai pm Grazia Pradella e Tiziana 
>> Siciliano emerge anche un caso nuovo: quello di EGD, 89 anni, 
>> operato nel 2005 per un "nodulo polmonare da non correlarsi né a un
>>  rischio di morte imminente o prossimo, né ad alcuna sintomatologia
>>  clinica", annotano i consulenti. The new advice prepared by pm 
>> Grazia Pradella e Tiziana Siciliano also emerges a new case: that 
>> of EGD, 89 years, worked in 2005 for a lung nodule or not related 
>> to a risk of imminent death or neighbor, nor to any clinical 
>> symptoms "record the relevant consultants. Nonostante questo, Brega
>>  Massone consigliò l'operazione e vi è una "relazione causale tra 
>> l'intervento di tracotomia eseguito in data 2 marso 2005 e il 
>> decesso". Despite this, Brega Massone advised the transaction and 
>> there is a causal relationship between the intervention of 
>> tracotomia performed on 2 mars 2005, and death. " I consulenti 
>> sembrano sbigottiti quando scrivono che "appare ancor più 
>> sconcertante, incredibile" la circostanza che i medici "ben 
>> sapevano" che il paziente aveva in corso addirittura un infarto 
>> miocardico acuto" ed erano "pienamente consapevoli del pressoché 
>> nullo beneficio che il trattamento chirurgico avrebbe portato" alla
>>  vittima. The consultants seem appalled when they write that "it 
>> seems even more baffling, amazing," the fact that doctors are "well
>>  aware" that the patient had even a course in acute myocardial 
>> infarction "and were" fully aware of almost no benefit to the 
>> surgical treatment would led "to the victim.
>> 
>> 
>> Tra le novità del'ultima ordinanza c'è la "sempre maggior 
>> autonomia" di Presicci e Pansera rispetto a Brega Massone, tanto 
>> che i due medici rivestono anche qualifiche di "primo operatore in 
>> una serie di interventi, tutti caratterizzati da particolare, 
>> quanto inutile aggressivita". The new ordinance is del'ultima the 
>> increasing autonomy "in Presicce and Panseri than Brega Massone, so
>>  that the two doctors are also qualifications" leader in a number
>> of interventions, all characterized by particular, as unnecessary 
>> aggressiveness. " E il gip rimarca lo "sconcertante quadro di 
>> aggressività costantemente operato al di fuori o in assenza di 
>> valido consenso informato, e non supportato da valide finalità 
>> terapeutiche". The GIP notes the "shocking picture of aggression 
>> consistently worked outside or in the absence of valid informed 
>> consent, and not supported by valid therapeutic purposes." 
>> All'elenco delle accuse devono aggiungersi anche alcune decine di 
>> nuove lesioni volontarie ai danni di pazienti della Santa Rita. To 
>> the list of accusations have also added dozens of new voluntary 
>> injury affecting patients of Santa Rita.
>> 
>> I pm avevano chiesto il carcere anche per sette anestesisti, ma il 
>> gip non ha accolto al richiesta, argomentando che a carico loro è 
>> ipotizzabile una "responsabilità omissiva" e nei loro confronti, 
>> quindi può "essere mossa una accusa di negligenza ed imperizia: 
>> appare quindi configurabile a loro carico un concorso colposo in 
>> delitto doloso". Pm I had also asked the jail for seven 
>> anesthesiologists, but the GIP has not accepted the request, 
>> arguing that their load is a possible liability omissions "and for 
>> them, so it can" be a move accused of negligence and incompetence 
>> appears configurable so dependent on them in a contest wrongful 
>> willful murder. " Rimangono quindi indagati a piede libero e la 
>> procura sta valutando se presentare ricorso al tribunale del 
>> Riesame per ottenere l'arresto dei sette. Suspects remain at large 
>> and the prosecutor is considering whether to appeal the court of 
>> review to obtain the arrest of seven.



> In the radio this morning, I listened to a discussion about a 
> Canadian over 70 who had to wait 3 years for heart surgery.

This is what happen also in Italy, maybe a bit less often than in Canada.
For example, when a limit to the queue is set (30 days, 60 days), it is
common to stop accepting requests until new slots will open.



> Another instance, (country unknown) after the age of 65, some medical
>  interventions are not covered/provided.

This is true everywhere, what change is what is not covered.
Anyway, many drugs are not covered as they are not considered
"life-savers" or "cost-effective".

Here an example:
http://www.emphysema.net/neighbours.html

"In Australia we have a choice of private insurance or Medicare. Private
insurance is expensive and so not everyone can afford it. However, for
those who can afford it, it will get you into hospital much sooner than
if you need to go public (for any number of operations or procedures).
Medicare covers the rest of the population.
..........
 As for the oxygen, I am not on oxygen as yet. But I believe the price
works along the same lines as above. I know a man who pays around $60 a
month for his wife's oxygen because he is a Realtor (Real Estate Agent)
who earns too much to qualify for the PBS.
The need for oxygen is determined much the same as it is in the USA. You
have to desaturate to a certain level before you can become eligible for
oxygen. Then the treatment of copd here in Australia is also much the
same as it is in the USA and probably all over the world."



> I faced this type of rigorous cut-off line when I tried to get 
> infertility aid in my mid-40s.  Because I was over 42 (the cut-off 
> age for infertility coverage), I could not get help from the HMO 
> insurance I was using at that time.  I had to pay out-of-pocket 
> thousands of dollars.

Here is the same.
In Italy the same depend where people live:
in Tuscany the limits for IVF treatments are 41 years and 11 months.
in Veneto is 42 years, Friuli 40 years.
Then, usually, there is a maximum number of procedure possible.
And it is better to not touch the idiotic laws about the procedure
itself. Let me say what the Catalan vice minister told a nurses
delegation I was with: a large part of the increase in low-cost planes
routes from Italy to Barcelona is for IVF procedures.



> As transhumanists, we desire to long, vital lives.  How will a new 
> healthcare system?s across-the-board set of rules affect us?  Would 
> our coverage expire at nature?s suggested human lifespan of 123-max? 
> Would those who do live longer than a considered the norm have to 
> fend for themselves, outside of the system?

Personal Experience Weighs on Obama in Health Policy Debate
http://www.nytimes.com/2009/05/01/us/politics/30web-baker.html?_r=1

>> “I don’t know how much that hip replacement cost,” Mr. Obama said
>> in the interview with David Leonhardt of The Times. “I would have
>> paid out of pocket for that hip replacement, just because she’s my
>> grandmother. Whether, sort of in the aggregate, society making
>> those decisions to give my grandmother, or everybody else’s aging
>> grandparents or parents, a hip replacement when they’re terminally
>> ill is a sustainable model is a very difficult question.”
>> 
>> He went on to say: “If somebody told me that my grandmother
>> couldn’t have a hip replacement and she had to lie there in misery
>> in the waning days of her life, that would be pretty upsetting.”
>> 
>> At the heart of the health care debate that will soon occupy
>> Washington is just that conundrum. As an intellectual matter, it’s
>> one thing to say that it makes no sense for a country to spend so
>> much on procedures that ultimately will do little to extend or
>> improve the lives of those nearing death. But as a personal matter,
>> it’s another to deny your own grandmother an operation that may at
>> least make her last days more comfortable.
>> 
>> Some conservatives have cited Mr. Obama’s story to make the case
>> that his plan to expand access to health care and reduce costs
>> ultimately will result in rationing, of the kind that might have
>> denied his grandmother the surgery unless she paid the bill on her
>> own.
>> 
>> “To me, Obama is laying out the intellectual case for health care
>> rationing while acknowledging the potential human costs of such a
>> policy,” wrote Matthew Continetti on the Web site of the Weekly
>> Standard magazine. “He’s saying that, in order to contain costs,
>> under a universal health care program his grandmother might have
>> been denied that hip replacement, or forced to pay for it herself.
>> This is the natural consequence of a universal policy, which would
>> bankrupt the country without some form of rationing care.”


Mirco