[FRIZ]

THE NEW YORK POST
October 14, 2003

SLOW ROAD TO HILLARYCARE
By NINA OWCHARENKO

http://www.nypost.com/postopinion/opedcolumnists/8003.htm

FIRST, the bad news: The Census Bureau says the number of uninsured Americans climbed by 2.4 million last year, to 43.6 million.
Now the worse news: Some will attempt to use this bad news to further expand the federal government's control of the health-care system. Presidential contender Rep. Richard Gephardt (D-Mo.) already has proposed spending more than $200 billion to provide what he calls "universal coverage."

But that's already happening - gradually, in bits and pieces. Health and Human Services Secretary Tommy Thompson recently bragged that some 2.4 million people are now covered under either Medicaid or the Children's Health Insurance Program. In fact, 25 percent of all U.S. children depend on one of these government programs.

That's good news in the short-term, since children need to see a doctor regularly. But in the longer term, it's a just one more step on the road to "HillaryCare" - the program of government-run, universal health-care that Americans rejected so decisively in the early Clinton years.

The problem, as the Clinton plan foretold, is that eventually bureaucrats will decide which medical procedures are covered and which aren't, with patients forced to see a government-approved doctor instead of choosing their own, and health-care services rationed (again, by bureaucrats) to hold down costs.

But there is something we can do to increase the number of people with coverage, while we also increase their free choice. The answer is a health-care tax credit.

Let's face it: Our current health-insurance system is broken, because the person using insurance is almost never in control of it. About two-thirds of insured Americans get their coverage through their employer. Most of the rest are in a government program such as Medicare or Medicaid.

These people are completely at the mercy of others. If their employer decides to drop coverage, or if the government changes its Medicaid policy, they can be left with no coverage. But a federal health-care tax credit would change that.

It would work like this: The federal government would give every taxpayer a refundable, advanceable credit that could be used only to buy health insurance. Such a tax benefit is really only fair, since the government already gives tax benefits to those buying coverage through their employer. This just puts the individual, not the employer, in charge.

This isn't government-run medicine. It would be a way for the government to encourage people to enter the private health-insurance market, where they would enjoy a growing number of choices.

The consumer-based approach offers people seamless health-care coverage. They wouldn't have to change plans - and, often, doctors - every time they change jobs. Under this system, health insurance would work the way car insurance, life insurance and homeowners insurance already do. Consumers could choose what coverage they need or don't need, and pay just for that.

Opponents will claim tax credits wouldn't work, because the private insurance market isn't large enough. That may be true now, but imagine how quickly companies would act to create a market if millions of Americans were suddenly seeking private coverage. Before long, Americans with tax credits would enjoy dozens of choices.

Individual states need to do their part, too. Each state regulates its own insurance market. In a noble attempt to make sure that everyone with coverage gets good coverage at a good price, many states mandate so many benefits and regulate their prices that most companies can't afford to offer insurance. That limits choice, and keeps many people from finding affordable policies. States must be willing to repeal some of their regulations and mandates, to allow the free market to work.

If there were suddenly millions of young Americans eager to spend their tax credit on health insurance, insurers would tailor plans specifically for them. The market would be created to meet the demand, prices would come down, and these Americans would leave the ranks of the uninsured.

So far, the only government-based answer to this problem is to expand program such as Medicaid. But cash-strapped states can't afford that. They're already finding ways to trim Medicaid benefits. Besides, studies show that when Medicaid expands, private insurance coverage declines. We need to encourage people to take control of their own insurance, not find ways to make more of them dependent on already failing government programs.

Large problems often require creative solutions. For a growing number of Americans, the lack of health insurance is indeed a crisis. But expanding government-controlled medicine isn't the answer.

Enable the free market to work by providing a tax credit, and in years to come, millions of Americans will move from uninsured to insured. That will be good news for everyone.


Nina Owcharenko is a senior policy analyst in the Center for Health Policy Studies at The Heritage Foundation.

[durango]

Your post is right on. It never ceases to amaze me how many people long for a Canadian style health system. There are many fine health professionals in Canada and some quality care, but what people fail to realize is that it is often very limited (wait times) and, most importantly, it is NOT free. It gets paid for in taxes, pure and simple. Proponents need to quit calling it free health care. Call it "paid by everyone with tax money" health care if you like. Then people can decide how much they want to pay for an overall decrease in service to most (and improvement for some).

[Standing Wolf]

Enable the free market to work by providing a tax credit, and in years to come, millions of Americans will move from uninsured to insured.

More tax loop holes have nothing to do with free enterprise.

[longeyes]

A tax credit is a subsidy, a transfer of wealth. Who is picking
up the tab for the 44 million people lacking health insurance? The
next question, at the risk of being a Blue Meanie, is why should they?

[Khornet]

what that number "X million uninsured" means.

Some are folks who want but can't get.
Some are folks between jobs, and new health plan not yet kicked in.
Some are folks who aren't bothering to seek insurance, for one reason or another.

That number means those without insurance AT THIS INSTANT, including those who will have it ten seconds from now, etc.

AND I want to know how they got the number. Did they talk to 44 million people? Not on your life. This number is some kind of extrapolation, and its value depends on the agenda of the extrapolator.

And as PJ O'Rourke says, if you think health care is expensive now, just wait till it's free.

[Iain]

Where does the US system leave people who need regular healthcare (check-ups, treatment and hospitalisation) in order to regulate health conditions that are out of their control?

You are born with a lung disorder say, if it is left untreated it will kill you by early teens. Treatment is improving all the time though. What if you have no access to this expensive treatment because no-one will insure you? No-one, like charities or hospitals, wants to pick up a regular tab, they will treat you if you need treatment right then and there as you are really ill, but what about the treatment needed to stop you getting ill in the first place?

Some medicines cost a few dollars, some cost thousands of dollars.

I am talking about a disease called Cystic Fibrosis. Most commonly genetically inherited disease amongst caucasians, approx 1 in 25,000 carries the gene, a couple who each carry the gene meet and have children then per child there is a 1 in 4 chance of that child having the disease. This is called 'recessive' inheritance. Unfortunately it is a 1 in 4 chance per child, so it can turn out that you have several children that appear healthy enough for some years but they may all have CF. How does this family end up when there is no healthcare that is 'free at the point of use' (the term used in the UK as opposed to 'free')?

As CF is a genetic disease there is the possibility that children born with the disease today may be offered 'gene therapy' at some point in the future, therapy that will effectively cure them. If it happens then as the system works here in the UK it will decided whether or not it is a therapy the NHS should offer, and yes, cost will be a factor it is not a perfect system. But what if there is no provision at all for gene therapy for some people? "Sorry little Timmy you have to die in your twenties because no-one wants to pay for the very expensive gene therapy."

I (because this is all about me of course, where do you think I got my knowledge?) can go to my doctor, because I am a chronic patient I would get seen today if I needed to be. If I needed to be admitted to hospital today, I would be. If I needed a heart/lung transplant (as I may do in the future) then I would go on a list, this list existing because of the shortage of organs, not because of the evils of this 'socialist system'. I need a treatment that is derived from human blood (from living donors) to boost my immune system, I need it every 3 weeks. I believe it costs the NHS over £20,000 a year for this treatment, but in the year before I had it I was admitted to hospital 5 times with pneumonic infections. I was 17, I weighed under 120lbs and they thought that terminal decline had set in. The treatment costs the tax payer a lot, but I have not been admitted to hospital once in the 5 years since I was started on it.

My uncle needs a triple coronary bypass, he went in today under the NHS. He didn't wait months, in fact he waited about two weeks from the date when they convinced him (he hates doctors) to have the surgery.

My consultant, one of the best in the world, is not poor because the NHS does not pay him. In fact the NHS salary for a consultant who is pretty much a part-timer is over £70,000 p.a I believe. It is also considered perfectly reasonable for consultants to work for the private system in the UK (it does exist) for extra money. The NHS is not perfect, it is bureaucratic and can be slow if you are not known to the system. Much needs to change, and some of those changes are being made.

I accept that this is a personal and impassioned defence of the system. What else can I say though? My parents had three children, all them were born with that 1 in 4 chance. Those three children have each had their life saved and their quality of life improved dramatically by the NHS. All three have been or are at university, ten years ago the vast majority of people with our disease didn't go to university, they didn't work, most didn't make it past 30. Medicine has advanced greatly, and the NHS gives me access to those advances and given me a chance to work and earn and have some number of years of normal life. Hopefully as many as 25 or 30 years from today.

[Iain]

I am kinda wondering what the answers to my questions are.

[Derek Zeanah]

Re: expensive life-threatening stuff you can't afford.

It's paid for. Go to the emergency room and you can't be denied service. They spend lots of money (read: tons) on terminally ill children. Imagine a case where a kid is born with multiple terminal defects, the mom still wants everything possible to be done, millions are dumped into care, and the mom decides she can't handle a kid who needs constant attention and will likely die before age 5 anyway. Goes into really expensive foster care.

Happens more than you know. And we all pay for it.

[Iain]

What if I turn up at the emergency room and demand to see a doctor so he can perform a check-up on me? Is that doctor a specialist in my field? Will they even see me?

[Derek Zeanah]

Yes, you'll get seen. But the triage nurse will see to it that more critically ill people go first, so you'll wait.

You might get a lecture from the doc too -- emergency rooms are expensive, and you'll end up costing everyone (or yourself, if you can pay) $500-600 for the visit, whereas it would have cost $80 at a normal doctor's office, and you'd have had better care to boot. And less of a wait. And someone who sees you regularly. And...

[Derek Zeanah]

I should make it clear that I don't like the way things are run now.

If your mom is dying and you want the hospital to dump $2 million into her care so she "lives" strapped to machines for an additional 3 weeks, cool. There's something to be said for having enough time to come to grips with the death of your loved one. But don't ask me to pay for it.

"Extraordinary measures" on a kid whose best shot is being a vegetable for the rest of his life? Bad choice, but if you insist on it then you pay for it.

Medical costs could be hugely reduced if we:

1) implemented good med malpractice reform.

2) Stopped spending so much money on the last few weeks of "life."

Another point: NPR story a few weeks ago when a caller called in with a counter-point: she has money deducted from her paycheck to go into a $5000 medical savings account, and everything is paid for out of that. She gets insurance for the stuff she can't pay for. Husband, wife, and 3 kids cost less than $150 per month in insurance.

There are better ways to go than what we've got now. But judging from my experience in the Army/having a German girlfriend, socialized medicine is not the way to get there.

[Skunkabilly]

I think there is concept in America, that there should always be guarantees and 'safety nets' for someone from cradle to the grave.

That's fine, but the bar doesn't have to be so low for the circumstances that require ALL of the village :rolleyes: to pay for it.

But I preach to the choir....

I went without health insurance for a year. It was MY fault. Because I was LAZY. I knew the risks and dealt with it by finding some cheap health insurance that weighed the risks with costs and benefits.

[Iain]

Derek - your example is fine and suits your case. But another example might be a child who needs surgery straight after birth to correct a congential heart defect, surgery that will sort the condition out once and for all but is expensive.

Someone is always willing to pay for the glamorous stuff like those conjoined twins, and the absolute emergency but what about ordinary everyday healthcare that someone like me needs? Can I afford $80 every time I go to the doctor - in recent memory I have needed to go several times a week and be prescribed drugs each time. Often those people that I see are top of their field in the UK even Europe. Would I get to see those type of people in the US?

All I hear from some Americans about this is either 'taxation is theft' or 'I don't want to pay taxes for those other sick people as I am healthy'. All well and good, but you give birth to a very sick child that needs constant medical attention to have any quality of life and you may well be singing a different tune.

[Iain]

I'd quite like to know some of the answers to these questions, I believe that they are crucial to most likely thousands of American citizens who need regular healthcare.

[Shalako]

This discussion can't be totally objective because life and death issues fuel it... One would feel like a real chump to deny you the care you need, but objectively, to all the others that we don't know, I would say that as a society we just can't save everybody. It would be cost prohibitive. There is a trade off between those that can be helped at a certain cost and those that can't be helped at another cost. Each society has to decide for their own where that line is drawn. Modern medical science and tax payer money can hold natural selection at bay for the time being, but does one's mere existence entitle them to be kept healthy and secure by the rest of the population? At what cost?

[MrAcheson]

The "who pays for it" is crucially important in health care. Why? Because you can always spend more on health care. There's never enough of it because people will always die at some point. You live through one disease to get sick again with something else. Its the nature of the beast.

Socialized medicine? Well evidentally the French system is good but very expensive. The British/Canadian system is cheaper (but still expensive by american standards) and its no where near as good. The Left wants us to adopt the British/Canadian system. No thanks.

As for the malpractice reform, yes but only because this country needs widespread legal reform period, not just in the malpractice field. Of course the government is run by lawyers so...

[Derek Zeanah]

Derek - your example is fine and suits your case. But another example might be a child who needs surgery straight after birth to correct a congential heart defect, surgery that will sort the condition out once and for all but is expensive.Reread what I wrote. I was talking about money dumped into prolonging life (oftentimes that "life" becomes nothing but pain and drug stupor, by the way), because these decisions are made by incredibly emotional people spending someone else's money. Stop doing that, and eliminate the abuses of the legal system in search of pain and suffering awards, and you might find that insurance is affordable. Hell, there's state-sponsored kid-care around here that costs $5 per month if the parents are willing to sign up for it.

Can I afford $80 every time I go to the doctor - in recent memory I have needed to go several times a week and be prescribed drugs each time. I don't know, can you? Over here, we have mommas in the hospital talking on a cell phone the entire visit, wearing a $120 funky haircut with 3" long expensive nails who claim they don't have teh $2 for a copay.

It might be time to talk about priorities.Often those people that I see are top of their field in the UK even Europe. Would I get to see those type of people in the US?Do you need to, or is a basic internal medicine doc sufficient for your needs? Do you want to pay extra to fly to Chicago to see a "top" doctor? Go for it. Just pay the fee.All well and good, but you give birth to a very sick child that needs constant medical attention to have any quality of life and you may well be singing a different tune.Every medical insurance policy I've had has included babies from the moment they're born. Re-read my above comment about the medical savings account and $120/month for a 5-person family's health insurance. That'll do, for everyone. It's a better solution than what we've got now.

I'd quite like to know some of the answers to these questions, I believe that they are crucial to most likely thousands of American citizens who need regular healthcare.Some of us work, and can't rrespond more frequently than every 2 hours. Sorry to keep you waiting. :neener:

[Iain]

Do I need to see the top doctors at times? Yep, one spotted a condition that no-one else had seen and it would probably have killed me without the treatment that I now receive. That treatment costs over £20,000 a year. Want to deny me it because I can't afford it? How many people have an extra £20,000 a year on top of mortgages and food and ... when they find it difficult enough to get and keep work due to ill health anyway?

That healthcare may cover the baby, but how long before the insurance company wants to back out under its contractual escape clauses as the costs mount? Genuine question.

You live through one disease to get sick again with something else. Its the nature of the beast.

Easy to say when you have been healthy, what if you have never been healthy? Give up and accept it? Tell you what, that cancer thing that is a result of society's affluence and that heart disease thing that also stems from there, they're not important. Stop spending money on them, see how people who hate 'socialised medicine' feel when they get themselves some of that there sickness - will they roll over and accept it as part of the 'nature of the beast'?

Modern medical science and tax payer money can hold natural selection at bay for the time being, but does one's mere existence entitle them to be kept healthy and secure by the rest of the population? At what cost?

It's an interesting point and to an extent I agree. However, Stephen Hawking developed his motor neurone disease after demonstrating his potential but before he achieved some great work. Should society let him and his kind fall by the wayside?

Have any of you needed medical care and genuinely not been able to afford it? I know people that hate dentists and so left toothache so long it became a serious abcess, that was their choice but it seems that under some systems some people have this forced upon them because they cannot pay.

[Derek Zeanah]

Do I need to see the top doctors at times? Yep, one spotted a condition that no-one else had seen and it would probably have killed me without the treatment that I now receive.Sorry -- you and I probably define "top doctors" differently. If you were to ask me, there are probably 10 "top ENT's" in the entire country.

How many people have an extra £20,000 a year on top of mortgages and food and ... when they find it difficult enough to get and keep work due to ill health anyway?Let me spell it out for you: i-n-s-u-r-a-n-c-e. I believe the free market provides this better than the .gov.That healthcare may cover the baby, but how long before the insurance company wants to back out under its contractual escape clauses as the costs mount? Genuine question.Genuine answer: they'll want to back out immediately to save money, but did you sign into a contract that allows them to do so? This is an easy fix, if the problem even exists.

[roscoe]

Let me spell it out for you: i-n-s-u-r-a-n-c-e. I believe the free market provides this better than the .gov.

I don't buy it. Health insurance companies are out there to make a profit; that is why they will deny coverage on existing conditions. In the US, if St. Johns did not qualify for group coverage under a government employee's plan, or a large corporation, he would simply be denied coverage for his cystic fibrosis.

Sure, he might get ER treatment when he had a serious infection caused by the disease, but diseases like CF require thousands of dollars a month in antibiotics and other drugs (pancreatic enzymes, etc.) to keep someone alive.

Medicaid covers a portion, but only if you are indigent. Where does that leave your average middle class American with a $50,000 salary and $40,000 in medical expenses for a chronic, but manageable disease, having been denied coverage by Blue Cross?

Screwed. Count on it. Medical care is simply too important to wait around while the free market tries to work itself out.

Remember, people always say that the free market 'works' because it corrects itself. That is like saying nature 'works' while the mastadons die off as the ice age ends. Sure, it 'works', but it is pretty ugly for the mastadons.

[fallingblock]

" Medical care is simply too important to wait around while the free market tries to work itself out."
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We have "free" health care here in Australia...and each time I've used it, the quacks either misdiagnosed my condition or made the problem worse with medication not correctly dosed. Why? Because they were public health hacks who get paid by the government through taxes everyone pays. Private is the way to go here if one seeks competent care...the downside is that you pay twice, and get the pointless bureaucracy into the bargain.


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Remember, people always say that the free market 'works' because it corrects itself. That is like saying nature 'works' while the mastadons die off as the ice age ends. Sure, it 'works', but it is pretty ugly for the mastadons.
************************************************************

The Mastodons were adapted for their habitat until a combination of human over-hunting and climatic change ended their run. Should we use tax money to keep the 'mastodons' of today alive, or should we address the social and environmental issues which are the primary cause of most of today's true health care problems?

If you want to pay for everbody else's health care, why not just turn your wage over to the nearest clinic, and let the rest of us keep more of what we earn?:D

[agricola]

Socialized medicine? Well evidentally the French system is good but very expensive. The British/Canadian system is cheaper (but still expensive by american standards) and its no where near as good. The Left wants us to adopt the British/Canadian system. No thanks.

The NHS in its current "trust" system is bad, and the foundation hospitals will probably make it much worse, leading to its collapse. However the original system was superb - it had extra capacity built into the system, provided free quality healthcare for every citizen and, if it had been left alone, would probably still be the shining beacon of excellence that it was for thirty years. You forget that the NHS and its staff were responsible for massive improvements in public health, improvements that are slowly being undone today by private enterprise interests

However, private industry and its champion Mrs. Thatcher saw fit to interfere, first poaching staff, and now equipment-time, from the NHS. I have no problem with BUPA recruiting NHS staff, provided they reimburse the public for the training the staff have recieved at the public's expense. Now BUPA and the like are going to have an interest in public health, and like Stagecoach taking an interest in rail travel, it is akin to leaving the fox in charge of the coop.

[Iain]

Thanks Roscoe, you saw my point. I seriously doubt I would qualify for health insurance but if any of you like then I will give BUPA (as mentioned by agricola) a ring and see how fast they slam the phone down.

Fallingblock

Why? Because they were public health hacks who get paid by the government through taxes everyone pays.

I don't see your point. Possibly one of the worst and most exploitative (of doctors) systems in the world is that of the Cubans, Cuba had a lower infant mortality rate than the US during the 1970's. Some of the best doctors in the world work within the NHS, I think I am right in saying that if I put my name down now then in about 10 years I could see Prof. Robert Winston the top man in possibly the world in the field of fertility. The list would be that long because fertility is not a crucial funding area for the NHS and because Winston does an awful lot of other work.

Sorry -- you and I probably define "top doctors" differently. If you were to ask me, there are probably 10 "top ENT's" in the entire country.

I don't define 'top doctors' differently. I see Dr. Stableforth at Birmingham Heartlands Cystic Fibrosis Unit. I believe there are three or four specialist units like this in the country and when the news has a CF issue on it then you have a pretty safe bet that either Stableforth was on the news or declined to be on the news. I owe the man my life plain and simple.

[fallingblock]

Good to see you back here at THR, by the way:)

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"I don't see your point. Possibly one of the worst and most exploitative (of doctors) systems in the world is that of the Cubans, Cuba had a lower infant mortality rate than the US during the 1970's."
************************************************************

The point is that the way the system is run here in Australia, the doctors have no incentive to provide quality health care....they are simply cogs in a great tax-funded bureaucracy that loses most of its talent to the U.S. and local private practice. It's rather a great waste of public funding, as the NHS in Britain has turned out to be. Those with exceptional health problems such as yourself have reason to be grateful for the confiscation of so much individual wealth, but genuine 'public health' is better served by a private health system with basic care for those too poor to access the system. It's an illusion to believe that any public system can provide specialist care for all without regard to ability to pay.:scrutiny:

As for those Cuban infant mortality numbers....a lot of those babies have migrated to the U.S., and many more would if they could.:D

[Iain]

I do agree with you about those babies - don't regard me as a communist.

On the whole I understand a lot of what you guys say about personal freedoms and taxation etc. I do fundamentally disagree on the subject of healthcare.

The point is that the way the system is run here in Australia, the doctors have no incentive to provide quality health care....they are simply cogs in a great tax-funded bureaucracy

That's fair enough, that is the way the system works now and I agree that it is less than perfect. As agricola points out though, it doesn't have to be that way.

Those with exceptional health problems such as yourself have reason to be grateful for the confiscation of so much individual wealth, but genuine 'public health' is better served by a private health system with basic care for those too poor to access the system. It's an illusion to believe that any public system can provide specialist care for all without regard to ability to pay.

'Confiscation' huh? I do return to the point that I bet many of you would view it differently if you needed the system but couldn't afford it. Derek asked if I can afford $80 each time I see the doctor in reality - the reality is yes, at the moment I see a doctor about once a month so that isn't too bad. In the past, and I can guarantee in the future too, five times a week is not unheard of. How much do you think a fortnight in an isolation ward with suspected TB costs? Or fortnightly courses of intravenous antibiotics? This isn't luxuries for someone like me - this is life or death. This isn't basic care either, this is highly involved care - there are about three folders in a hospital with my name on, each records hundreds of visits, tests and hospitalisations. Not basic stuff.

And don't be thinking that health problems like mine are 'exceptional'. I have already cited heart disease and cancer as two things that many on this board will have faced or have to face - such is the reality of modern western life.

[dustind]

Slightly off track, but if you train someone that person owes you for it, not the person that benefits from the training such as your employer. If I give you a car you owe me, not the person who you decide to give a ride in the car. Same thing with borrowing money.

Here is my experience. When I was in the tenth grade I had constant stomach pain, for months I was seeing doctors and specialists. I was finally diagnosed with partial malrotation in my intestines. My intestines did not go under my stomach and loop back, instead they made a tight loop that almost kinked off the line. Anyway it cost ten dollars a visit because we had insurance, my five day hospital stay after surgery was also cheap, I doubt we spent over a thousand dollars for the whole four month ordeal. I made a full recovery by the way.

I think forcing someone to pay for someone else is simply stealing, but I do see the difference between legitimate health care and people throwing money away because it is free which is much worse. I hate to be cruel but it comes down to "whos money is it?" I guess you could also ask "is quality of life more important than freedom?" or "is it right to steal to save a life?"

I hope you get better St Johns.

[Iain]

I'm not ever going to get better dustind, unless they do make 'gene therapy' work. Congenital and eventually terminal.

'Is it right to steal to save a life?' They had this argument in New Zealand when they did away with cradle-to-grave. They found that people were in such desperate poverty situations that they were needing to steal to live, this being odd as NZ is a very large exporter of food.

Where does US healthcare leave people like me? I suggest you guys go out and have a look for people like me in your community and ask them how they function and if they think the Canadian, French or UK systems would serve them better.

And don't be thinking that these diseases will go away under 'natural selection'. The genetic mutation that causes my disease is believed to have originated in Europe in the 15th Century - so people have had this disease for near 600 years - the gene hasn't disappeared, people are still being born with the gene and others with the disease pretty much everyday. This is despite the fact the disease used to kill in infancy and certainly before reproductive age. In fact it is quite likely that someone you know or have met carries the gene.

Some hard questions for US healthcare.

[fallingblock]

"The genetic mutation that causes my disease is believed to have originated in Europe in the 15th Century - so people have had this disease for near 600 years - the gene hasn't disappeared, people are still being born with the gene and others with the disease pretty much everyday. This is despite the fact the disease used to kill in infancy and certainly before reproductive age. In fact it is quite likely that someone you know or have met carries the gene."
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Two questions which may seem a bit pointed, but are to the point:

1. Are you planning to reproduce?

2. Are you willing to accept the responsibility for promoting the gene?

Why should taxpayers pay for specialist care for your offspring?:scrutiny:

[Iain]

Those questions are perfectly fine. As I said the disease used to kill sufferers before their teens so it wasn't them passing the gene on.

Recessive genetics. Not the best picture but here goes:

http://www.musckids.com/health_library/genetics/images/genedefects_b.gif

Obviously red and blue indicate gender, the letter 'r' underneath indicates the copies of the gene the individual has. 'R' is the normal and dominant gene. 'r' is the mutated and recessive gene. You have two copies of this gene, one from mother and one from father. Majority of the population have the following:

'RR' - they are healthy.

Some have:

'Rr' - they are healthy, but they 'carry' the disease.

So if two people with that 'genotype' meet then they each will pass on one copy of that gene to a child. There are 4 copies available (mother - Rr and father Rr) so each child has the following possibilities available:

RR - fine, non-carrier
rR - carrier
Rr - carrier
rr - sufferer

If a carrier meets and has children with a non-carrier then the children have the following possibilities available to them:

RR - non-carrier
Rr - carrier.

Thus the disease continues to pass through the generations without sufferers having children. CF is the classic recessive inheritance model.

As to me, I am 22 and have thought long and hard about children. I can categorically state that I do not want to have children, it is unfair to knowingly pass my dodgy genes (all my children would be carriers as they have to inherit one of my 'r' genes and I have two). Besides in 95% of CF males the disease causes infertility and in females the stress of pregnancy can cause severe decline.

Children aren't a right is the way I view it.

[Malone LaVeigh]

Thanks for the thought-provoking perspective, SJ.

As to the original post, it should be pointed out that the Clinton healthcare proposal was a far cry from "universal coverage." Even that tepid reform effort was shot down by the insurance companies alarmed by the loss or revenue from their free money machine.

Unfortunately, this country won't have anything like a British or Canadian system until we reach a real crisis. The poor are already there, of course, but who cares about them, they don't make big campaign contributions.

[fallingblock]

Your civility is appreciated:) .

"Children aren't a right is the way I view it."

My own view is that any 'right' (and act in general) confers responsibility. I tend to the point of view that IF one chooses to be a parent, then one bears the responsibility of that act. You are actually taking the high ground responsibility-wise by weighing carefully the consequences of passing on a known problematic recessive gene before rather than after the fact. Of course it is modern medical science which allows us the choice in this case.

What do you think about so called "chronic" users of public health funds-
those who to choose to abuse their health with substance use and criminal lifestyles? Should they be allocated all the health care that a responsible citizen should?:confused:

It is after all their continuing choice of an self-abusive lifestyle which brings them into the health care facilities more frequently than the responsible citizen.

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"And don't be thinking that these diseases will go away under 'natural selection'. The genetic mutation that causes my disease is believed to have originated in Europe in the 15th Century - so people have had this disease for near 600 years - the gene hasn't disappeared, people are still being born with the gene and others with the disease pretty much everyday. This is despite the fact the disease used to kill in infancy and certainly before reproductive age. In fact it is quite likely that someone you know or have met carries the gene."
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I'm a botanist, a plant taxonomist to be specific, but I have studied genetics a bit along the way. It seems to me that if the 15th Century is the earliest known occurence of the disease, then it has been around for an insufficient time for natural selection to have been effective in reducing it, especially given the selection-thwarting nature of human society. My guess would be that it is one of those conditions that affect too few of the population at large to be a large player in selection. Those THR members who work with or are more familiar with human genetics and epidemiology perhaps could shed some light on this.


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"'Is it right to steal to save a life?' They had this argument in New Zealand when they did away with cradle-to-grave. They found that people were in such desperate poverty situations that they were needing to steal to live, this being odd as NZ is a very large exporter of food.
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I am also a New Zealand citizen, having lived there right through the Lange/Douglas years, during the inevitable demise of "cradle-to-grave" social welfare.

My wife in fact was employed the Christchurch Department of Social Welfare (now WINZ) office for 12 years before we shifted to Australia. I do not know where your information about "desperate poverty" in N.Z. was sourced, but it is not correct :( .

IF any New Zealander is in desperate enough straights to steal food, s/he has only themselves to blame, as everyone who is unemployed in N.Z. and willing to at least pretend to look for work is still entitled to a full benefit (dole) of unlimited duration...until their age superannuation kicks in if need be, as are those with disabilities which prevent them from working.

The much-publicised-by-the-left cases of desperate poverty were linked to chronic drug and alcohol abusers who spent their benefit on substances, then stole for food, as well as de-institutionalised mental patients who opted to 'disappear' from the system.

You can check this info yourself at:

http://www.workandincome.govt.nz/get_financial_assistance/index.html

New Zealand is still wrestling with the effects of the crippling expense of decades of outrageous social welfare spending, and the changes which curbed some of the most egregious examples were in fact, just in time to avoid a collapse of the N.Z. economy.:eek:

[fallingblock]

"Unfortunately, this country won't have anything like a British or Canadian system until we reach a real crisis."
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We'll NEVER have one like the British or Canadian system...now THAT would be a crisis:what: :eek:

[JoshM]

Fallingblock, Well said

St Johns
'Is it right to steal to save a life?' They had this argument in New Zealand when they did away with cradle-to-grave. They found that people were in such desperate poverty situations that they were needing to steal to live

Rubbish, The most stolen items from NZ stores/supermarkets are condoms, candy, CD's, tobacco, and booze.

Even the poorest people in NZ have problems with obesity. During the neoliberal period of the 1980's there was economic and social turmoil, but nobody starved and I don't remember any serious arguments about the "right to steal to live" either.

[Iain]

An offhand comment about something I read from a NZ methodist minister about five years ago - maybe that info was wrong.

What do you think about so called "chronic" users of public health funds-
those who to choose to abuse their health with substance use and criminal lifestyles? Should they be allocated all the health care that a responsible citizen should?

As I understand it tobacco taxes pay for a lot of the NHS in the UK, in a way the NHS needs smokers, then again smokers are a large proportion of those who are 'irresponsible' with their health.

CF genes - no, not a major player in natural selection so they're not going away and will always be there costing some health service somewhere money. Unless of course pre-natal testing and compulsory abortions of 'diseased' foetuses comes in. Do we want to see that?

I'm still wondering what kind of health situation I personally would be in if I was born in the US.

[Khornet]

We treat 'em. Simple as that. Every damn day. Every day I treat people who will never pay me. All us docs in the US do.

I'm one of those specialists, St John. A gastroenterologist. When my phone rings in the middle of the night because someone is puking blood, I get up and go fix it. There is no question about what his insurance coverage is, or what his income. There is no discussion about payment plans. I just treat him. Later, he'll get a bill of course. The honorable ones will come to my office and work out a plan; there are lots of folks paying me $10 a month on a $2000 bill. The others just skip. Some of these others have recurrent problems, and I've treated them without pay repeatedly. All of us have patients like that.

To qualify for Medicaid, which is health coverage for the poor, you have to be....POOR. Is that the fault of the health care system, or the doctors? No one need go untreated here, but you can't drive up to the hospital in a Cadillac and expect Medicaid to pay for your care.

St. Johns, good to hear from you again. My equivalent of you is a chronic hepatitis C patient. I have loads of them. Most of them are pretty poor. Some I treat for free, though I am legally obliged to bill them. Most I treat for a pittance. I can do this because the other patients who have money or insurance do pay me, so I can make a living. Thus the 'haves' take care of the 'have nots', without a big govt. bureaucracy in the middle.

[fallingblock]

"CF genes - no, not a major player in natural selection so they're not going away and will always be there costing some health service somewhere money. Unless of course pre-natal testing and compulsory abortions of 'diseased' foetuses comes in. Do we want to see that?
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With the ongoing debate concerning the release of genetic profiles to government and various private agencies, it may be a matter of sooner rather than later regarding pre-natal testing...or perhaps 'permission to parent' genetic scans. The Chinese haven't been all that successful with forced abortions as a population control measure, but with information technology improving at its current rate, such a scenario is not unlikely.

:uhoh: