The best demonstration of how a country can be so rich and yet so totally third-world.

This story is so Virginia Tech. So deeply sad, and what's this third-world country going to do about it? Wait, wait, don't tell me. Oh yes, nothing.

This emotionally wrenching story only distracts from our need to create universal health care. The form of health care used will never change this kid's story. Is there a magic number you are looking for here? How does $10 million sound? Then let's have Nevada give that to those 40 other families.
Can you wrap your head around what $400,000,000 could do in preventative, prenatal, imunization, sanitation and all sorts of other care just in Nevada?

This kid's fate is sad and I'm sure everybody feels very sorry about it. But just what is accomplished here other than using him for an "Oprah" momment?

dc

*Deleted*

Dear Prof. Warren: another great post, another great cause, and a worthy battle to fight.

A separate definition of profit must be imposed by law on insurers and all that relates to them in cases like this.

A suggestion: in most cases a medically fragile child or adult, an AIDs patient, and so on, are immune suppressed persons. NOT treating them could cause the intensification and development of bacteria and microbes and fungi which would not otherwise be a threat, and which could find their way into the mainstream . . . including blue blood flows . . . killing the most profitable investors.

I liken this to extremely rich folks, for example a man who lives in an Alaskan wild who wants to block a gravel mine because he knows it will damage not only the $ value of his land, but the invaluable intangible values there -- the solace in nature's well being that can make a mortal person glad that all is well with some other section of living worlds.

It's so true that what comes around goes around; the greatest profit in the world is to give, even to the point of giving all. What's this mean? It is a component of heroism which we award in our troops when they give their lives or limb for their compatriots, and how would it be different if an insurance company were to give of its profit to enhance the care of children? A heroism award could come to them, and having sought them first the Kingdom of Heaven (of such are the children) the rest would be added to them ... progress against disease in general ... advances ... and perhaps a grateful policyholding public and taxpaying public willing to see some financial reward flow back to insurers who do what's good even until it hurts investors financially ...

I'd even suggest a certain sponsorship program for children like this within insurance company policy holders AND investors, whereby those who really are big time sick can be advertised to policy holders and investors for sponsorship in which many will pay a little extra on their policies to cover the boy or girl or needy person sponsored ...

We can and must do better, and those things not mandated by the US Constitution which are dumbfoundingly leftover from less humane, more deceived and less aware ages, MUST GO.

This story is heart-tugging and I guess some of the responses are affected by that, as is understandable. What I find puzzling about those responses, however, is that, in lambasting insurers, they don't seem to recognize that the action reported is not the insurer's action, but a state's action. Every insurance system I know of insures risk to a limit and then the state takes over the claims that fall outside the insurance, or lets them lie where they fell. Against that backdrop, those responses that advocate that THIS kind of insurer should uniquely be required to provide unlimited protection against risk - and presumably those posters are not saying "just for Matthew" but for all 300 million of us - are not grounded in the real world. No "for profit" company would ever assume such risks and, if it was forced to, it would not survive long, as its capital would bleed away over a modest time horizon, and then what would happen to the "insured" population once it failed. The government cannot force investors to invest in such a doomed enterprise. Ultimately the question of coverage of those like this poor family must fall to a government to finance through taxes, or to provide free or heavily subsidized care via state agencies, or to let the loss lie. In a country of over 300 million, there are, quite frankly, reasonable arguments on all sides of that decision. The one thing that should be indisputable is that the resolution of this issue has nothing to do with any workable system of private insurance.

While I agree that the case here is terrible, and must be a heartbreaking and awful situation for this family to go through, I think it's unfortunate that this discussion went off the rails so quickly. Health policy discussion on TPMCafe often reflect a deep, visceral hatred of private enterprise that's all-too-common in the leftie blogosphere, and that seems to shove aside serious discussion in favor of "O'Reilly Factor"-style angry rhetoric.

A couple points to make about this situation. First, while reasonable people can contend that health care is a basic human right (and I won't entirely agree or disagree), it's important to remember that that doesn't mean it's free. Whether you have a private healthcare system or a government-based system, the provision of care chews through resources, and by definition anything that chews through resources has a cost. Moreover, because of the nature of coverage and service provision, these costs nearly always apply in a regressive fashion. So the idea that shoehorning the U.S. into a nationalized system and eliminating private coverage will be a panacea for everything may not hold water; in fact, given that we overdiagnose and overtreat like hell in the U.S., my guess is that universal coverage would be massively more expensive and wasteful than our current system, even if a single payer corrects the apocryphal "inefficiencies" of the current system.

Another point - and this might sound terrible to say, though I don't mean it to - is that we Americans tend to act as though we're entitled to a full, healthy life, and we expect other people to move heaven and earth to make that happen for us. While it's clear that Matthew and his family did nothing to lead to the awful situation they find themselves in, it seems that he was dealt a particularly shitty set of cards by life, something that can happen to any of us. But is it necessarily someone else's responsibility to make this all better, to make a serious congenital illness not so? I'm not trying to argue things one way or the other, but I think it says something about us as a society that we feel the need to somehow save everyone, no matter how heroic the effort required, and that we feel the need to cast about and blame everyone we don't like when we encounter any obstacle to that.

Why don't you read my post again? How does a high deductible equate to being thrown out onto the street? And thanks for mentioning smokers, I forgot to include them.

Surely you aren't arguing that people who drink or smoke or eat to morbid excess have a legitimate claim on my time and money even if they refuse to submit to corrective medical treatment.

Or do you moan, roll your eyes, and call that coercive, as if nobody should ever be required to do anything??? Maybe it's a 500-pounder's constitutional right to have society pay for her diabetes? A two-pack-a day smoker's God-given right to free lung resection if his disease is caught soon enough?

In any case, you don't address the real, looming problem that health care expenditures threaten to take all available funds, sooner than we think.

When I read unhinged posts like yours, I really worry. Do you by any chance work for a drug company?

And hasn't your Mommy taught you that it is bad form to downrate a comment to which you are responding?

Well, you seem a bit testy to me. Maybe I shouldn't be required to pay for your increased risk of heart attack or high blood pressure and new studies show clinical depression is linked to stress so relax. Life is much easier when you aren't running the universe you know and judging who are good and who are bad and who are worthy by how they look to you could cause unnecessary fatique and we would't want you to nod off and cause a wreck and thus be denied health care due to your failure to stay fully awake.

The most constructively health conscious woman I ever had the good fortune to know was a physical ed teacher and my best friend's mother. She died in her fifties and spent her last year in a coma due to a mosquito bite. I suppose you'd have denied her health care since she didn't use adequate insect repellant.

I'm all for evidence based health care and preventive care that includes attention to good nutrition and other healthy lifestyles. But you sound like an insurance bean counter to me. All ready to inspect the genetic code of your neighbor so you can figure out a reason to deny him health care based on his irresponsibility in being born with a bad set of genes.

As a society, we benefit when people discover miracle cures and new techniques -- not that I would encourage false hope when a child is beyond the realistic possibility of medical help. When I was a child there were no kidney transplants. Would you deny a child a kidney transplant now?

I'm not going to make people with substance use disorders health care villains and poster children for the campaign against universal health care. There are complex causes and difficult if not impossible recoveries for many with such disorders which at least in part are caused by a genetic predisposition.

I see no moral imperative for covering lifestyle drugs. But the same system that would deny care to Michael, would more than likely be paying for Viagra for someone his grandfather's age.

There should be a Federal research program to care for these extremely rare, costly patients. It would increase medical knowledge while saving lives and preventing families from being bankrupted.

And no, I'm not going to defend cryogenically freezing peoples' brains in remote, human-digital interfaced spaceship computers or whatever other ridiculous nonsense the reductio-ad-absurdists think I should have to defend in order to believe in universal health care.

So if this applies to you, knock it off and quit being absurd.

The real case is ... when it happens to you.

So what if Michael here isn't the most common case. How many times do you run into people who have not the most common case. Seems to me it happens all too frequently. What if Michael had cancer or autism or had been hit by a car. Any number of problems might cause you to max out on your insurance.

I always think of a man who worked for a company I once worked for. He was out on a Sunday afternoon with his wife and 3 kids all belted in the car, driving down a rural interstate, fully insured, fully employed and fully obeying the law.

A car crossed the median, hit his car, killed his wife, critically injured him, left one kid with a severe TBI, one with a severed spinal cord and one not seriously injured.

So of course within months his family was reduced to begging on local TV.

Why do we do that to people? Everyone of us is only one distracted driver away from bankruptcy. If you think you aren't you must have a large trust fund.

Survival of the fittest has become the dominant philosophy over the past couple of decades...

overall, I think that general health care has improved but the "health care elephant" in the room is really the "near the end of life" health care costs since it's both labor and resource intensive.

solve that problem, and you'll be rich!

To boldly go...

Re: overall, I think that general health care has improved but the "health care elephant" in the room is really the "near the end of life" health care costs since it's both labor and resource intensive.

One reason that these costs are so high is that most people at the end of their lives are fairly well-insured via Medicare and a medigap insurance policy. Hence providers tend to over-treat them, or simply inflate the charges, in order to jack up the bill. The excuse being that they have to make up for money lost on underinsured and uninsured patients and the chronically ill offer them the opportunity to do this. Here's a question: what are expenditures for end of life care in Canada, France, etc? This shoudl give us an idea how much is being overbilled to cover the costs of the the unreimbursed care.

"Would you deny a child a kidney transplant now?"
Your turn to make a decision: If this child has gone through five kidney transplants, say every two or three years, do you decide to give him #6, or do you put the resources toward another child that probably won't reject the kidney?
You seem to be of the opinion that some people here are making cruel choices dictated by money. I can think of no system that does not have limits. It is not immoral to impose those limits in order to make our society as a whole better for it.

BTW, for all you know grandpa had road rage until he got his viagra.

dc

Wigmari--

You make it sound so simple--just go for treatmet and anyone can stop eating, drinking, smoking . . .

Unfortunately, addictive behavior is often tied up with serious psychological and physical problems that medical science just does not know how to solve. Over-eating is a good example. All of the newest best medical evidence shows that we haven't yet figured out how to help truly obese people take the weight off--and keep it off. When they try, their body chemistry conspires against them (their metabolism slows down.)

And we just haven't been able to untangle the combination of physical, psychological and hereditary factors that causes some people to become obsese. Presumably this is like cancer--there are a number of different diseases at work here.

Of course we could insist that obese people
have their stomachs stapled. But this is, in fact, a pretty dangerous operation, and we are just learning about the long-term side effects (which could wind up costing society more than if the obsese person simply kept on eating and ultimately died young of a heart attack.)

Alcoholics Anonymous has had some real succcess in helping people stop drinking--but their track record is still far from 100 percent--even when people really, really want to stop because they know they will (or have already) lost their chldren,their spouses, their jobs.

Many of these people are self-medicating because they are severely depressed. And depression medications don't help everyone.

So while it's easy to say "Why should I pay for these people if they won't submit to treatment?" the point is that we don't have treatments to help many of these people.

Just be very glad that you were not born with (or never developed) an untreatable illness.

That's a medical decision. I'm not arguing for replacing medical decisions with wishing for miracles nor am I arguing for prolonging the life and suffering of someone with no realistic prospect of a good outcome. I'm arguing for making these decisions medical, not financial.

Sure, virtually any resource is limited but if we were making these decisions based on the best medical evidence and the best medical practice I believe we'd save a lot of money in the long run.

This shoudl give us an idea how much is being overbilled...

I won't speculate since I agree with your point about cost shifting.

To boldly go...

I notice you don't even try to pay lip service to the fact that we will soon be bankrupting ourselves funding health care.

I don't care what is causing them to become morbidly obese. You wave depression around as an all-purpose justification for the staus quo. If they're depressed, give 'em antidepressants, by and large they work as well as, or better than, $120/hr twice a week for five years. They need to lose the weight. Every pound gained is 4000 kcal excess food taken in. Period. And the new stomach surgery is laparoscopic and reversible.

Heavy drinkers need to quit, and there are drugs available to help them. Smokers need to quit, and ditto. Both programs may require mandatory medication, because most failures in these medication programs are caused by patient noncompliance, not a psychological or metabolic condition.

I did not say the treatment actually had to succeed, all I said was that they could not refuse it. Most such treatment failures are caused by patient noncompliance, not a psychological or metabolic condition.

"I would start by making these disqualifying conditions for standard health insurance after the individual refuses fair opportunities to self-correct, via monitored intake of Temposil or Antabuse perhaps coupled with therapy for alcoholism, or bariatric surgery for weight loss.

Such an individual should be restricted to a means-tested, higher-deductible policy so he feels the financial pain the condition is causing as it worsens. If you can get some reaction with incentives, maybe he won't become a million-dollar case."

If they don't really try, then the hell with them, to the high-deductible policy (NO, NOT THE STREETS) they go.

Finally, you say: "Just be very glad that you were not born with (or never developed) an untreatable illness."

You are assuming facts not in evidence. Morbid obesity, toxic smoking and drinking to excess are all treatable. So, whether or not one has an "untreatable illness" has little or nothing to do with the issues here, which are how to provide reasonable health care while attaining fiscal sanity. Also, it seems to me that your "knowledge" of the state of my health is merely an assumption built on your own prejudices-- "If that bastard only had an untreatable illness he wouldn't be so hard on all those poor people who are drinking, eating, or smoking themselves to death and expecting the public to pay for it."

"I don't care what is causing them to become morbidly obese. You wave depression around as an all-purpose justification for the staus quo. If they're depressed, give 'em antidepressants,..."

Too bad there's no drug to treat your ignorance.