On 02/29/12 09:24 am, Kurt Ullman wrote:
Ran across this article, Han,
http://www.thirteen.org/bid/sb-howmuch.html

Among the highlights:
Medicare did a major analysis of end-of-life spending trends in 1993,
looking at data for 1975, 1980, 1985, and 1988. Gerald Riley, Medicare
actuary, conducted the analysis with colleague James Lubitz and
published it in the 1993 New England Journal of Medicine. They found no
evidence that elderly persons in the last year of life account for a
larger share of Medicare expenditures today than before the onslaught of
technology. In fact, Medicare paid the exact same percentage for
patients in the last two months of life in 1976 as in 1988.
€ 27 to 30 percent of Medicare payments cover the cost of care for
people in the last year of life.
€ 40 percent of Medicare dollars cover care for people in the last
month.
€ 12 percent of Medicare spending covers people who are in the last
two months.
€ 10 percent of Medicare beneficiaries account for 70 percent of
program spending.


Dr. Riley reappeared last year in Health Services Research. Using the
Continuous Medicare History Sample, containing annual summaries of
claims data on a 5 percent sample from 1978 to 2006, he found the share
of Medicare payments going to persons in their last year of life
declined slightly from 28.3 percent in 1978 to 25.1 percent in 2006.
After adjustment for age, sex, and death rates, there was no significant
trend.

Health Serv Res. 2010 Apr;45(2):565-76. Epub 2010 Feb 9.
Long-term trends in Medicare payments in the last year of life.
Riley GF, Lubitz JD.

And I read recently in another newsgroup a claim that physicians
themselves tend to refuse expensive procedures that would extend their
life by only a few months.

Perce

Kurt Ullman wrote in
:

The problem is that everytime that gets tried, we get bogged down on
what is "basic" insurance. Dialysis is the least of our worries
personally (FWIW) since you automatically qualify for Medicaid if you
need dialysis.

Whether it is paid for by Medicaid/are is immaterial (IMO) since it is
costly and has to be paid for. The (relative) nonsense of the treatment
is when it is to keep people alive in their last year of life, when it is
certainly not much of a life with quality. I experienced some of that
3rd hand when a relative of a coworker went through this, and I have seen
first hand the toll of caring for a dying relative on the caregivers.
Other than very frequent trips overseas during my parents' last years, I
was personally relatively unaffected (well ...). So one question is why
not more people decided to write down and notarize their desires as to
what should be done in case ... etc. The other question is whether
society should formalize more of the options when those last moments
become a question of what to do.

I do realize those things are very personal, and touch on religious
beliefs as well as feelings of the soon to be bereft, and I will respect
whatever decisions are made. But it should be considered beforehand
(IMNSHO).

--
Best regards
Han
email address is invalid

Kurt Ullman wrote in
:

Checked around: 1 percent of the population accounts for 30
percent
of the nation's health care expenditures. ABout 30% of MCare's budget
is spent on those in the last year of their life. It is largely
because you are sickest before you die. Sorta hard to argue.
I have thought (though never have had the money to actually finance
such a study--maybe if I hit Powerball tonight) that this was a little
skewed.
I had an Uncle that died of a heart attack. The last year of his
life he had expenditures of around $50,000, with 90% of that being in
the time frame from when he came to the hospital to when he died about
6 hours later (including a chopper ride from rural Arkansas to Little
Rock to try a bypass). I have always wondered how much of that 30% is
acute treatment (he was still alive when he landed at Little Rock, but
died during surgery because of the damage) giving the guy a chance and
how much was essentially PR/CYA treatment of someone already gone. I
obviously have a much different view of the latter than the former.

Yes. Maybe this is inevitable. It is very difficult to decide when to
let nature take its course. In hindsight that helicopter ride was
expensive and useless. But sometimes people (young or older) do survive
and lead meaningful lives afterwards. (not sure what PR/CYA is). Uncle
may or may not have had DNR or similar instructions, but my wife and kids
have instructions to honor my wishes and not exert extraordinary measures
to keep my body alive. Any useful spare parts may be harvested grin.

--
Best regards
Han
email address is invalid

Kurt Ullman wrote in
:

Ran across this article, Han,
http://www.thirteen.org/bid/sb-howmuch.html

Among the highlights:
Medicare did a major analysis of end-of-life spending trends in 1993,
looking at data for 1975, 1980, 1985, and 1988. Gerald Riley, Medicare
actuary, conducted the analysis with colleague James Lubitz and
published it in the 1993 New England Journal of Medicine. They found
no evidence that elderly persons in the last year of life account for
a larger share of Medicare expenditures today than before the
onslaught of technology. In fact, Medicare paid the exact same
percentage for patients in the last two months of life in 1976 as in
1988.
€ 27 to 30 percent of Medicare payments cover the cost of care
for
people in the last year of life.
€ 40 percent of Medicare dollars cover care for people in the
last
month.
€ 12 percent of Medicare spending covers people who are in the
last
two months.
€ 10 percent of Medicare beneficiaries account for 70 percent
of
program spending.


Dr. Riley reappeared last year in Health Services Research. Using the
Continuous Medicare History Sample, containing annual summaries of
claims data on a 5 percent sample from 1978 to 2006, he found the
share of Medicare payments going to persons in their last year of life
declined slightly from 28.3 percent in 1978 to 25.1 percent in 2006.
After adjustment for age, sex, and death rates, there was no
significant trend.

Health Serv Res. 2010 Apr;45(2):565-76. Epub 2010 Feb 9.
Long-term trends in Medicare payments in the last year of life.
Riley GF, Lubitz JD.

Thanks for the references, and the data! Seems to confirm that it is
expensive to be sick, and that afterwards you still die ... So the
question needs to be restated - and it is definitely a selfish question -
should people be encouraged to limit their use of the most expensive
forms of care in their last moments? Something everyone needs to
consider, IMO.

--
Best regards
Han
email address is invalid

In article ,
Han wrote:


was personally relatively unaffected (well ...). So one question is why
not more people decided to write down and notarize their desires as to
what should be done in case ... etc. The other question is whether
society should formalize more of the options when those last moments
become a question of what to do.

The answer to your first question is (I think) largely secondary to
people in US don't think they are going to die. We don't talk about it,
we don't want to think about it. Cultural in nature.
I am not all that comfortable in "society" deciding these kinds of
questions for the individual. Although I am equally concerned about
society having to PAY for certain types of Hail Mary care. Just another
thing I don't think we as a society have hashed out yet, unlike others.
Although I do think one thing that society (ie lawmakers) should do
immediately is give these force of law. I have seen bunches of time when
I was serving on my hospital's ethics committee where the patient had
the proper paperwork, but the family intervened and required "everything
that could be done should be done for grandma", usually with all sorts
of threats of legal and/or going to the press involved. The physicians
and hospitals need better cover in the situations where the more vocal
relatives don't want to give up.

I do realize those things are very personal, and touch on religious
beliefs as well as feelings of the soon to be bereft, and I will respect
whatever decisions are made. But it should be considered beforehand
(IMNSHO).
Everybody that enters the hospital for any reason is given a brochure
on living wills, powers of attorney for health care, etc. Most ignore
them, including I am somewhat embarrassed to admit, me.

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

In article ,
Han wrote:

Kurt Ullman wrote in
:

Checked around: 1 percent of the population accounts for 30
percent
of the nation's health care expenditures. ABout 30% of MCare's budget
is spent on those in the last year of their life. It is largely
because you are sickest before you die. Sorta hard to argue.
I have thought (though never have had the money to actually finance
such a study--maybe if I hit Powerball tonight) that this was a little
skewed.
I had an Uncle that died of a heart attack. The last year of his
life he had expenditures of around $50,000, with 90% of that being in
the time frame from when he came to the hospital to when he died about
6 hours later (including a chopper ride from rural Arkansas to Little
Rock to try a bypass). I have always wondered how much of that 30% is
acute treatment (he was still alive when he landed at Little Rock, but
died during surgery because of the damage) giving the guy a chance and
how much was essentially PR/CYA treatment of someone already gone. I
obviously have a much different view of the latter than the former.

Yes. Maybe this is inevitable. It is very difficult to decide when to
let nature take its course. In hindsight that helicopter ride was
expensive and useless. But sometimes people (young or older) do survive
and lead meaningful lives afterwards. (not sure what PR/CYA is).
Sorry, PR (Public Relations)/CYA (cover your ass).
Uncle
may or may not have had DNR or similar instructions, but my wife and kids
have instructions to honor my wishes and not exert extraordinary measures
to keep my body alive. Any useful spare parts may be harvested grin.

The other distinguishing factor was that Uncle was 57 at the time.
One of things that doesn't often get involved with discussion.

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

In article ,
Han wrote:

Thanks for the references, and the data! Seems to confirm that it is
expensive to be sick, and that afterwards you still die ... So the
question needs to be restated - and it is definitely a selfish question -
should people be encouraged to limit their use of the most expensive
forms of care in their last moments? Something everyone needs to
consider, IMO.
That is the wrong question. The real thing at issue is WHEN should
people be encouraged to limit their use? At what threshold of survival
should we cut off treatment? At what quality of life years measure
should we conclude it is time for Grandad to turn off the lights because
the party is over? Oregon Mcaid (one of the first experiments with
rationing of care) has long had a cut off where if your 5 year survival
rate isn't above a certain threshold you don't get a second round of
chemo. But how do you transcribe that to even the vital and robust 70
year old who may get 10 or more years of life out of an expensive
cardiac catheterization or stent? How about the less than vital and
robust 60 year old in the same situation.
WHen you can figure out those concerns, PLEASE let me know. (g).

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

Kurt Ullman wrote in
:

In article ,
Han wrote:

Thanks for the references, and the data! Seems to confirm that it is
expensive to be sick, and that afterwards you still die ... So the
question needs to be restated - and it is definitely a selfish
question - should people be encouraged to limit their use of the most
expensive forms of care in their last moments? Something everyone
needs to consider, IMO.
That is the wrong question. The real thing at issue is WHEN should
people be encouraged to limit their use? At what threshold of survival
should we cut off treatment? At what quality of life years measure
should we conclude it is time for Grandad to turn off the lights
because the party is over? Oregon Mcaid (one of the first experiments
with rationing of care) has long had a cut off where if your 5 year
survival rate isn't above a certain threshold you don't get a second
round of chemo. But how do you transcribe that to even the vital and
robust 70 year old who may get 10 or more years of life out of an
expensive cardiac catheterization or stent? How about the less than
vital and robust 60 year old in the same situation.
WHen you can figure out those concerns, PLEASE let me know. (g).

I can't answer your question because, as a liberal person, or at least as
a free person (pun intended - please don't take offense) and even as a
fiscally conservative person, the question is one of personal preferences
and/or beliefs. That is why it is important for everyone to consider
these questions and make a statement as to what they would like done to
them when the moment comes that they can't decide for themselves. Plus
assign what is called in NJ a "durable power of attorney for health
care", to a person who will make decisions for you when you can't. And
be sure that your family and friends know of this.


--
Best regards
Han
email address is invalid

Kurt Ullman wrote in
:

In article ,
Han wrote:


was personally relatively unaffected (well ...). So one question is
why not more people decided to write down and notarize their desires
as to what should be done in case ... etc. The other question is
whether society should formalize more of the options when those last
moments become a question of what to do.

The answer to your first question is (I think) largely secondary to
people in US don't think they are going to die. We don't talk about
it, we don't want to think about it. Cultural in nature.

Death, like taxes, is something we all like to ignore. That is something
totally ineffectual, and people should realize that.

I am not all that comfortable in "society" deciding these kinds of
questions for the individual. Although I am equally concerned about
society having to PAY for certain types of Hail Mary care. Just
another thing I don't think we as a society have hashed out yet,
unlike others.

I am not talking all that absolute in terms of a score of 100 is the cut-
off, 99 and you live, 101 and you die. But I think that there could be
somewhat more objective measures to help individuals decide for themselves,
make hospital social workers and chaplains better aware of, and make family
and or friends understand the alternatives. These are things we all have
to deal with eventually, sometimes much, much sooner than we would wish.

Although I do think one thing that society (ie lawmakers) should do
immediately is give these force of law. I have seen bunches of time
when I was serving on my hospital's ethics committee where the patient
had the proper paperwork, but the family intervened and required
"everything that could be done should be done for grandma", usually
with all sorts of threats of legal and/or going to the press involved.
The physicians and hospitals need better cover in the situations where
the more vocal relatives don't want to give up.

I believe that assigning a "durable power of attorney for health care" to
someone you trust should help. I am not a lawyer, so I don't know the ins
and outs of what a hospital and the doctors involved in such decisions are
liable for, or required to do. It seems to me that if I become comatose or
terminally ill, that my wishes are clear and I believe that my spouse or my
kids will honor my wishes of not becoming a vegetable. Maybe there is a
need for legislation to absolve a hospital or doctors from any legal
consequences if they follow the legal wishes of the person involved. Then
that should be formulated in a simply to understand way and enacted
forthwith.

I do realize those things are very personal, and touch on religious
beliefs as well as feelings of the soon to be bereft, and I will
respect whatever decisions are made. But it should be considered
beforehand (IMNSHO).

Everybody that enters the hospital for any reason is given a brochure
on living wills, powers of attorney for health care, etc. Most ignore
them, including I am somewhat embarrassed to admit, me.

Yes, they are and yes they do, but that dioesn't make that correct! I can
go out of my way and post the documents I signed and you can change what
you want and sign them in front of a lawyer. We finally made new wills and
all the faldera around them and paid the lawyer for the work. I hope the
papers will yellow over time, before we need them, but it is a piece of
mind that the decisions have been made and formalized officially.

--
Best regards
Han
email address is invalid

Kurt Ullman wrote in
m:

In article ,
Han wrote:

Kurt Ullman wrote in
:

Checked around: 1 percent of the population accounts for 30
percent
of the nation's health care expenditures. ABout 30% of MCare's
budget is spent on those in the last year of their life. It is
largely because you are sickest before you die. Sorta hard to
argue.
I have thought (though never have had the money to actually
finance
such a study--maybe if I hit Powerball tonight) that this was a
little skewed.
I had an Uncle that died of a heart attack. The last year of
his
life he had expenditures of around $50,000, with 90% of that being
in the time frame from when he came to the hospital to when he died
about 6 hours later (including a chopper ride from rural Arkansas
to Little Rock to try a bypass). I have always wondered how much of
that 30% is acute treatment (he was still alive when he landed at
Little Rock, but died during surgery because of the damage) giving
the guy a chance and how much was essentially PR/CYA treatment of
someone already gone. I obviously have a much different view of the
latter than the former.

Yes. Maybe this is inevitable. It is very difficult to decide when
to let nature take its course. In hindsight that helicopter ride was
expensive and useless. But sometimes people (young or older) do
survive and lead meaningful lives afterwards. (not sure what PR/CYA
is).
Sorry, PR (Public Relations)/CYA (cover your ass).

Yes, there is that, especially if Uncle is fairly young. And rightly so.
An EMT can say this guy needs care, but only a doctor can say he's dead.

Uncle
may or may not have had DNR or similar instructions, but my wife and
kids have instructions to honor my wishes and not exert extraordinary
measures to keep my body alive. Any useful spare parts may be
harvested grin.

The other distinguishing factor was that Uncle was 57 at the time.
One of things that doesn't often get involved with discussion.

One more reason to discuss it and act on it!!

--
Best regards
Han
email address is invalid

On 29 Feb 2012 18:13:19 GMT, Han wrote:

That is why it is important for everyone to consider
these questions and make a statement as to what they would like done to
them when the moment comes that they can't decide for themselves.

I agree completely. That is precisely why the government should not
be allowed to dictate a treatment or lack thereof. It seems that we
now have a government with diametrically opposed views from that when
we prosecuted Dr. Jack Kevorkian.

Gordon Shumway wrote in
:

On 29 Feb 2012 18:13:19 GMT, Han wrote:

That is why it is important for everyone to consider
these questions and make a statement as to what they would like done to
them when the moment comes that they can't decide for themselves.

I agree completely. That is precisely why the government should not
be allowed to dictate a treatment or lack thereof. It seems that we
now have a government with diametrically opposed views from that when
we prosecuted Dr. Jack Kevorkian.

My views. I know not everyone thinks like me ...

I think it is in the purview of the insurer to set some limits. Despite
some miracles, people in persistent vegitative states aren't going to
enjoy their grandchildren. If the taxpayer has to ante up the costs, I'd
say that "we" are justified to require some progress in the condition of
the patient before paying for more than say 6 month of care.

Kevorkian was a gadfly, but there are people who suffer and see no useful
life ahead. If their doctor and at least 2 capable uninterested
specialists agree that the patient has no future then I's permit the
patient to end his/her life. Not that this should be granted easily. I
know of a woman in her 80s in Holland who had unbearable pains from
untreatable cystitis, which also confined her to her house. She was
consistently denied permission to end her life despite her wishes to do
so. Of course I only have her say so, but I knew her fairly well. Her
condition lasted more than 10 years, IIRC, until she did pass away.

--
Best regards
Han
email address is invalid

Kurt Ullman writes:

In article ,
Han wrote:

Thanks for the references, and the data! Seems to confirm that it is
expensive to be sick, and that afterwards you still die ... So the
question needs to be restated - and it is definitely a selfish question -
should people be encouraged to limit their use of the most expensive
forms of care in their last moments? Something everyone needs to
consider, IMO.
That is the wrong question. The real thing at issue is WHEN should
people be encouraged to limit their use?

Wasn't this resolved in the ACA?

Ie. the doctor can charge for consulting with the patient on
this issue. (Sometimes referred to as "Death Panels".)

So the answer is, as of ACA, it's between the patient and the doctor.

Seems like a reasonable first try to me.

--
Dan Espen

In article , Dan Espen
wrote:

Kurt Ullman writes:

In article ,
Han wrote:

Thanks for the references, and the data! Seems to confirm that it is
expensive to be sick, and that afterwards you still die ... So the
question needs to be restated - and it is definitely a selfish question -
should people be encouraged to limit their use of the most expensive
forms of care in their last moments? Something everyone needs to
consider, IMO.
That is the wrong question. The real thing at issue is WHEN should
people be encouraged to limit their use?

Wasn't this resolved in the ACA?

Not my knowledge. In fact the main force, according to the President
himself, the The Independent Payment Advisory Board, or IPAB,
specifically is forbidden to enter this realm. (In real life because of
the fact it is forbidden to do much of anything, it won't function, but
that is beside the point, I guess.

Ie. the doctor can charge for consulting with the patient on
this issue. (Sometimes referred to as "Death Panels".)
I am not sure what you are talking about, unless it is the part that
they can get reimbursed for talking about durable powers of attorney,
etc. The death panels were a completely different thing altogether.


So the answer is, as of ACA, it's between the patient and the doctor.
Not to my understanding. Feel free to prove me wrong.


Seems like a reasonable first try to me.

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

Kurt Ullman writes:

In article , Dan Espen
wrote:

Kurt Ullman writes:

In article ,
Han wrote:

Thanks for the references, and the data! Seems to confirm that it is
expensive to be sick, and that afterwards you still die ... So the
question needs to be restated - and it is definitely a selfish question -
should people be encouraged to limit their use of the most expensive
forms of care in their last moments? Something everyone needs to
consider, IMO.
That is the wrong question. The real thing at issue is WHEN should
people be encouraged to limit their use?

Wasn't this resolved in the ACA?

Not my knowledge. In fact the main force, according to the President
himself, the The Independent Payment Advisory Board, or IPAB,
specifically is forbidden to enter this realm. (In real life because of
the fact it is forbidden to do much of anything, it won't function, but
that is beside the point, I guess.

Okay so IPAB has nothing to do with advising patients about limiting
care before death.

Ie. the doctor can charge for consulting with the patient on
this issue. (Sometimes referred to as "Death Panels".)
I am not sure what you are talking about, unless it is the part that
they can get reimbursed for talking about durable powers of attorney,
etc. The death panels were a completely different thing altogether.

Were they?

According to Wikipedia "Death Panels":

Palin specified that she was referring to Section 1233 of bill HR 3200
which would have paid physicians for providing voluntary counseling to
Medicare patients about living wills, advance directives, and
end-of-life care options.

So the answer is, as of ACA, it's between the patient and the doctor.
Not to my understanding. Feel free to prove me wrong.

Same here.

--
Dan Espen

In article , Dan Espen
wrote:



Ie. the doctor can charge for consulting with the patient on
this issue. (Sometimes referred to as "Death Panels".)
I am not sure what you are talking about, unless it is the part that
they can get reimbursed for talking about durable powers of attorney,
etc. The death panels were a completely different thing altogether.

Were they?

According to Wikipedia "Death Panels":

Palin specified that she was referring to Section 1233 of bill HR 3200
which would have paid physicians for providing voluntary counseling to
Medicare patients about living wills, advance directives, and
end-of-life care options.



Maybe Palin, but most of the death panel stuff I heard at the time had
to with thins like the IAPB that they were going to put into place that
would decide coverage issues and what would and would not be paid for. I
always thought that was one of the dumbest arguments because there have
ALWAYS been people deciding what would and would not be paid for. Even
MCare doesn't automatically for every new treatment and medication upon
release. You had it pre-ACA and you will have it post-ACA. You had it in
the privates and you had it in the governmental.


--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

Kurt Ullman writes:

In article , Dan Espen
wrote:

Ie. the doctor can charge for consulting with the patient on
this issue. (Sometimes referred to as "Death Panels".)
I am not sure what you are talking about, unless it is the part that
they can get reimbursed for talking about durable powers of attorney,
etc. The death panels were a completely different thing altogether.

Were they?

According to Wikipedia "Death Panels":

Palin specified that she was referring to Section 1233 of bill HR 3200
which would have paid physicians for providing voluntary counseling to
Medicare patients about living wills, advance directives, and
end-of-life care options.

Maybe Palin,

I'm pretty sure Palin owns the death panel issue.
She should have trademarked it at the time.
"Death panels" and "pals around with terrorists" are her finest works.

but most of the death panel stuff I heard at the time had
to with thins like the IAPB that they were going to put into place that
would decide coverage issues and what would and would not be paid for.

Pundits trying to make sense of nonsense.

I always thought that was one of the dumbest arguments because there
have ALWAYS been people deciding what would and would not be paid
for. Even MCare doesn't automatically for every new treatment and
medication upon release. You had it pre-ACA and you will have it
post-ACA. You had it in the privates and you had it in the
governmental.

Yep, someone does have to decide.

Forget about the government, the scariest person to have decision power
is an insurance company claims agent.

--
Dan Espen

In article , Dan Espen
wrote:

Forget about the government, the scariest person to have decision power
is an insurance company claims agent.

Why? They work in exactly the same way. Heck with privates at least they
don't invoke sovereign immunity so you can theoretically sue them.

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

"Kurt Ullman" wrote in message

You had it pre-ACA and you will have it post-ACA. You had it in
the privates . . .

But some penicillin cleared it right up!

--
Bobby G.

In article ,
"Robert Green" wrote:

"Kurt Ullman" wrote in message

You had it pre-ACA and you will have it post-ACA. You had it in
the privates . . .

But some penicillin cleared it right up!


The literature clearly shows that there are definite signs of resistance
beginning to appear (grin).

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

"The Daring Dufas" wrote in message
...
On 2/28/2012 4:02 PM, Robert Green wrote:

stuff snipped

I love his stereotypes and misconceptions about
my own region of the country. ^_^

Name some. Please. I'm always willing to learn and correct my errors.
I
may have some opinions about conservatives at large, but that in no way
limits them to the Southern states. (-" A lot of what I believe about
the
South is based on the nature of the laws passed in the South, how they
fare
when it comes to standardized testing, their voting records, problems
endemic to their area, etc. IOW, clearly verifiable facts and not just
opinions. If I've got those wrong, fire away and 'edumacate' me. (And
yes,
I will confess that when I hear someone turn the word "school" into one
having four syllables, as in "Sk-ah-ew-ell" I wince just a little. But
I
wince the same way when I hear Canadians, eh, talk the way they do, eh
and
when a New Yawker tells me "it's on toity-toid street near the cawfee
shop.")

stuff snipped

So what is it about the South you think I've been so "stereotypical"
about
or to put it another way, "politically incorrect" about? Remember,
criticizing *you* doesn't count. That's personal! (-:

--
Bobby G.


Bobby, I come from a multi-species family with Roman Catholics, Jews and
space aliens on the maternal side and Southern Baptists, Methodists,
Druids and a group who worships some sort of fungus that glows in the
dark caves they live in on the paternal side.

I'm about the same. Much of Europe is represented in my genes.

I'm everyone's cousin which gives me the right to pick on anyone.

On that we disagree. I don't believe blacks should be able to call each
other the "N" word as a gesture of friendship and then blow a gasket when
some allegedly "unauthorized" person uses that word. Believing you have the
right to "pick on" someone because of membership in their group is basically
the same thing. Neither is right.

Mom and Dad were both in
the army during WWII so they're both buried at Arlington National
Cemetery. Mom was a New York Democrat and Dad was a Southern Republican.
I'm neither, Republicans disgust me but Democrats are special, they
horrify me. Bobby, you make the mistake of thinking that I take Usenet
seriously and that I believe everything I read or hear.

This gigantic gush of a response by you leads me to believe that you're
being facetious again. If you didn't really care, 100's of words wouldn't
be pouring out of you in machine gun bursts. (-:

As far as Right
Wing talk radio goes, I can assure you, I don't listen to Rush Limbaugh,
Sean Hannity, Glenn Beck, Laura Ingraham and others on a regular basis.
I listen to whatever I find entertaining at the moment and choose to
look up multiple sources whenever I hear something. If I find it funny,
I may post it to tweak the snozolas of the P.L.L.C.F. types who operate
with an emotional rather than a rational mindset.

And you were saying what about *MY* stereotypes? You've just made a blanket
sort of statement about all liberals, haven't you? That they are emotional,
not rational. That's just not true. Look at rational, unemotional Southern
liberal Jimmy Carter, a graduate of the US Naval Academy. (-:

You did make assumptions about the "anti-ILLEGAL" immigration bill passed
by
the legislature of Alabamastan or you were parroting the silly lies you
may have heard that the P.L.L.C.F. types have been spewing about a law
they never even bothered to read.

Which is it? Making assumptions or parroting lies (or what)? And if I was
parroting lies, exactly what lies were they? Saying "I did make
assumptions" without specifics is almost as frustrating as when a woman says
you've made her mad and when you ask her why, she says "You know!" Well, I
don't know.

I recall quoting a Brit paper that interviewed Alabama residents about their
reaction to the law. How is that "parroting lies?" Apparently growers are
leaving fruit to rot because they have no one willing to work for those
wages except immigrants. Is that a lie? That very same thing happens
almost every time there are immigration crackdowns. That's why these
crackdowns are always so half-hearted. Growers call their Congressmen or
reps after they occur and say "do you want produce costs to quadruple?" and
the lawmakers back down. Are there not people in Alabama that are demanding
that at least some parts of the new laws be modified or revoked? Are there
no legal challenges surfacing?

I actually spoke with one of the
legislative sponsors of the bill and suggested that "ILLEGAL aliens" be
denied access to civil courts if they ILLEGALLY entered the country
under their own volition but not those kidnapped and enslaved. I do find
it quite funny that the P.L.L.C.F. types can never define the word
"racist" which is their favorite swear word they apply to everyone or
every thing they disagree with, especially laws that prohibit ILLEGAL
activity by mostly minorities.

That's another stereotype - that liberals can't define racist. It's pretty
simple, really. "The doctrine that a certain human race is superior to any
or all others." The Nazis were racists. White supremacists are racists.
OK, another of *your* stereotypes busted. But wasn't this supposed to be
about you making clear which of my "stereotypes and beliefs" you found so
enjoyable?

I can bust another of your stereotypical
assumptions, neither me or my eight siblings sound like Jeff Foxworthy
unless we want to as entertainment for our Yankee relatives. I suppose
it may have something to do with the fact that both parents taught
college courses at one time or another and we all grew up speaking
correct English. I don't and never have used "y'all" in normal
conversation unless I'm hamming up a "stereotypical" Southern accent. My
Hillbilly character is only one of many I use when calling a radio talk
show. It's a great deal of fun to call as several different people
during one of the local programs. ^_^

Go back and read what I wrote. I criticized several geographic areas for
the very different ways they pronounce the English language. That's not
racist, it's observational. I've spent months in Alabama and I've heard the
regional dialects. Blindfolded I would know whether I was in a McDonald's
in NYC or Montgomery, Ala. or Toronto, Canada, eh? (-: You would, too.
It's just because there ARE regional dialects not only in the US, but all
over the world. Do ALL southerners say "Y'all?" - of course not. Neither
do all NYC residents say "toidy-toid" instead of "thirty-third." But an
awful lot of them do. Enough to make it them both part of recognized
dialects.

I'm probably one of the few people you know who can reliably spot the
differences between Australian, New Zealand and South African accents. It
took a lot of work, a fair number of Kiwi films (all four of them) set on
endless loop, etc. but I finally can get it almost always right. Is that
racist? I don't think so. It's just a question of hearing someone say "I'm
getting a cheek" and realizing it's a New Zealander saying they're getting
paid ("getting a check"). When you hear them say "the cat in the hat sat
back" ("the ket in the het set beck") y'all will know you're a talkin' to a
Kiwi. Hell, I rail on my own NY cousin for her "cawfee tawk" by shouting
out "Speak ENGLISH!"

I'm still not sure what stereotypical behavior you're accusing me of, but
you've certainly exposed a few of your own. "A man shall accuse others of
what he himself is most guilty of." (-:

Care to try again?

--
Bobby G.

"Kurt Ullman" wrote in message
...
In article ,
"Robert Green" wrote:

"Kurt Ullman" wrote in message

You had it pre-ACA and you will have it post-ACA. You had it in
the privates . . .

But some penicillin cleared it right up!


The literature clearly shows that there are definite signs of resistance
beginning to appear (grin).

Resistance is futile. I couldn't 'resist' such a perfect straight line.
(-:

--
Bobby G.

In article ,
"Robert Green" wrote:


that that's the heart of the problem with ACA. No one wants to feel they're
paying for someone else's free ride. But that's what insurance is all
about. To pool resources enough to meet isolated risks. How do you fairly
allocate inputs and outputs in such a system? that into getting people to
live healthier lives when they're on their deathbeds? The huge number of
people who still smoke is a testament to how hard a row prevention is to
hoe.
Actually I think one of the things that needs to happen is that
there are things put into the system that reflect the extra costs. Car
insurance is set up so if you have a bad driving record you pay more.
Why shouldn't health insurance? (BTW I am speaking as a guy who weighs
too much and would probably be hit with higher costs, too.)



My favorite health care example of mis-directed dollars is MRSA. Until
recently there was no particular financial reason for hospitals to care much
about patients who became infected with anti-biotic resistant staph
infections during their *first* hospital stay. In fact, there was almost a
perverse incentive NOT to care because an iatrogenic MRSA infection usually
meant another lengthy hospital stay ($$$$) to cure it. We've discussed
incentives before, and I agree with you: punishing a doctor for a patient's
bad outcome isn't the proper path. Medicare will now not pay for MRSA
treatment. Will punishing a hospital for bad outcomes achieve a good
result? I haven't seen any followups studies yet.

Me neither, but if it is implemented prior to this information and it
works out that it doesn't work, then good luck getting it reversed. (g).

.

Absolutely. The models are there, both in other insurance industries and
across the world. There's no doubt that once all the smoke clears that
universal health care is a doable thing. Many other non-socialist,
non-communist and non-fascist countries have been able to make it work. I
feel it's a pretty serious indictment of our system of government if we
*can't* make it work when so many other countries can.

Nah, it is just a function of being in America. We have had hard
times doing anything until it is nearly a lost cause. Just our way of
hashing things out.

Unfortunately, there are many who would prefer to throw up smoke screens of
lies and distortions in an attempt to make it fail. The mere fact that they
have to resort to such outlandish techniques as claiming there will be
"death panels" indicates that there's not much they can throw up in the way
of real, fact-based opposition.
There WILL be death panels. There has to be death panels. BOTH sides
have studiously ignored that realilty and thrown up mutual smoke
screens.


That hasn't stopped them from trying again with religious-based
organizations complaining they don't want to be associated with birth
control in any way. They don't have to. Their insurers will.
If it is THEIR insurers, then the amount of money they pay as part of
the deal with their employees is their money and they pay for it. This
is the part Liberals are studiously ignoring.

Ironically,
this latest roadblock thrown up by the opposition actually *makes* the case
for a "government option." If private insurers or self-insurers don't want
to deal with birth control or any other moral objection, give those
employees the right to insure their health through the government. This
reason alone is why the system will eventually evolve to have a government
option.
No, actually it works to MY favorite issue in that ALL of the money
should be given to the employee and let them do what they want with it.
If a person is buying their own insurance, they can add or subtract what
they want. I don't like the tyranny of the government any more than I
like the tyranny of the employer.


As the Romneycare experiment illustrated, there are still issues to be
resolved, but that doesn't mean they can NEVER be resolved. Many other
countries with far less wealth have done. As you noted, it's a question of
spreading out the risk. That was the failure point in Massachusetts -
people entering and leaving the pool of insured. If that pool becomes all
American citizens, entering and leaving becomes somewhat irrelevant because
you'd have to renounce your citizenship to leave the pool. It won't be as
easy as missing a premium payment.

Or, as in MA, just pay the fine because it is cheaper than the insurance
and then get in and out of the system as needed. Even if the mandate
stays, it is largely a joke.


U
We saw this same sort of opposition to Medicare and even Social Security.
While not quite as hysterical as today's opposition (i.e. death panels), the
histrionics didn't stop the train, they only slowed it down a bit. When
Bush tried to take SS private it came close to sinking him, politically.

Instead it will sink the US fiscally later on. And if you want to
talk about hysterical opposition, Bush's plan was 100% voluntary,
involved only a portion of the money so there was still an albeit lower
guarantee. And don't EVEN Get me started on "what happens if the stock
market crashes when I retire".



--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

Kurt Ullman wrote in
m:

In article ,
"Robert Green" wrote:


that that's the heart of the problem with ACA. No one wants to feel
they're paying for someone else's free ride. But that's what
insurance is all about. To pool resources enough to meet isolated
risks. How do you fairly allocate inputs and outputs in such a
system? that into getting people to live healthier lives when
they're on their deathbeds? The huge number of people who still
smoke is a testament to how hard a row prevention is to hoe.
Actually I think one of the things that needs to happen is that
there are things put into the system that reflect the extra costs. Car
insurance is set up so if you have a bad driving record you pay more.
Why shouldn't health insurance? (BTW I am speaking as a guy who weighs
too much and would probably be hit with higher costs, too.)

This is a rather difficult problem. As a former smoker who had stopped
and then started again when stress levels rose, I know. How are you
going to take that into account? And yes, I am overweight too. But all
that should be part of the invoice, I think.

My favorite health care example of mis-directed dollars is MRSA.
Until recently there was no particular financial reason for hospitals
to care much about patients who became infected with anti-biotic
resistant staph infections during their *first* hospital stay. In
fact, there was almost a perverse incentive NOT to care because an
iatrogenic MRSA infection usually meant another lengthy hospital stay
($$$$) to cure it. We've discussed incentives before, and I agree
with you: punishing a doctor for a patient's bad outcome isn't the
proper path. Medicare will now not pay for MRSA treatment. Will
punishing a hospital for bad outcomes achieve a good result? I
haven't seen any followups studies yet.

Me neither, but if it is implemented prior to this information and it
works out that it doesn't work, then good luck getting it reversed.(g).

Well, there have been tests that bear on this. Your hospital and doctors
will perform better if they are forced (somehow) to wash their hands more
often. Surgery has fewer preventable bad outcomes, if the use checklists
to see what is left over at the end (all scissors accounted for? All
sponges?). Seems to me that incentives to do the above plus penalties
for those types of bad outcomes will work.

Absolutely. The models are there, both in other insurance industries
and across the world. There's no doubt that once all the smoke
clears that universal health care is a doable thing. Many other
non-socialist, non-communist and non-fascist countries have been able
to make it work. I feel it's a pretty serious indictment of our
system of government if we *can't* make it work when so many other
countries can.

Nah, it is just a function of being in America. We have had hard
times doing anything until it is nearly a lost cause. Just our way of
hashing things out.

Unfortunately, that seems to be the case ...

Unfortunately, there are many who would prefer to throw up smoke
screens of lies and distortions in an attempt to make it fail. The
mere fact that they have to resort to such outlandish techniques as
claiming there will be "death panels" indicates that there's not much
they can throw up in the way of real, fact-based opposition.
There WILL be death panels. There has to be death panels. BOTH
sides have studiously ignored that realilty and thrown up mutual smoke
screens.

I agree there will be and I think there should be discussion between
hospital & doctors with patients and family/loved ones to establish what
kinds of "heroic measures" should be applied when decision time comes.
And better to have that discussion sooner than later.

That hasn't stopped them from trying again with religious-based
organizations complaining they don't want to be associated with birth
control in any way. They don't have to. Their insurers will.
If it is THEIR insurers, then the amount of money they pay as part
of the deal with their employees is their money and they pay for it.
This is the part Liberals are studiously ignoring.

Well, whatever you call me, I am not ignoring that. But I have perhaps
another take on it. In my opinion, taxes and compulsory insurance should
not be subject to choice, whether with a religious fig leaf, or any other
fig leaf. It is generally not accepted when you are asked to pay taxes
to fund national security expenses.

Ironically,
this latest roadblock thrown up by the opposition actually *makes*
the case for a "government option." If private insurers or
self-insurers don't want to deal with birth control or any other
moral objection, give those employees the right to insure their
health through the government. This reason alone is why the system
will eventually evolve to have a government option.
No, actually it works to MY favorite issue in that ALL of the
money should be given to the employee and let them do what they want
with it. If a person is buying their own insurance, they can add or
subtract what they want. I don't like the tyranny of the government
any more than I like the tyranny of the employer.

That seems awfully close to having a mandated low(ish) level of
compulsory insurance for everyone, with a choice of more insurance for an
additional premium. And actually it is taxing policies that make the
employer pay for health insurance. I think it goes like this: The
employer is allowed a tax deduction for the premiums, which make it very
advantageous for both employer and employee. If there was no tax
deduction for the employer, he/she/it would have to pay an increased
salary, but that would make the extra income of the employee taxable.
Since that hits the more well-paid employee hardest, it is a certified
no-go!

As the Romneycare experiment illustrated, there are still issues to
be resolved, but that doesn't mean they can NEVER be resolved. Many
other countries with far less wealth have done. As you noted, it's a
question of spreading out the risk. That was the failure point in
Massachusetts - people entering and leaving the pool of insured. If
that pool becomes all American citizens, entering and leaving becomes
somewhat irrelevant because you'd have to renounce your citizenship
to leave the pool. It won't be as easy as missing a premium payment.

Or, as in MA, just pay the fine because it is cheaper than the
insurance and then get in and out of the system as needed. Even if the
mandate stays, it is largely a joke.

In Mass, it was mostly successful. One of the problems was that the
costs of their system were (drum-roll, you'd never suspect this)
underestimated. I'm not sure whether it was overutilization by the
patients or increased use of tests etc by the doctors/hospitals. That
neatly confirms similar experiences in the Netherlands, but things there
are much more strict and simple than here.

We saw this same sort of opposition to Medicare and even Social
Security. While not quite as hysterical as today's opposition (i.e.
death panels), the histrionics didn't stop the train, they only
slowed it down a bit. When Bush tried to take SS private it came
close to sinking him, politically.

Instead it will sink the US fiscally later on. And if you want to
talk about hysterical opposition, Bush's plan was 100% voluntary,
involved only a portion of the money so there was still an albeit
lower guarantee. And don't EVEN Get me started on "what happens if the
stock market crashes when I retire".

That's another kettle of fish. I retired November 2010, and the employer
subsidized supplementary insurance for my wife and me was $106/mo. Now
it is $200/mo. And still the stock market isn't back to where it was in
2007. My home's assessed value went down 25%.

--
Best regards
Han
email address is invalid

In article ,
Han wrote:



Me neither, but if it is implemented prior to this information and it
works out that it doesn't work, then good luck getting it reversed.(g).

Well, there have been tests that bear on this. Your hospital and doctors
will perform better if they are forced (somehow) to wash their hands more
often. Surgery has fewer preventable bad outcomes, if the use checklists
to see what is left over at the end (all scissors accounted for? All
sponges?). Seems to me that incentives to do the above plus penalties
for those types of bad outcomes will work.
For these things that are in the control of the professionals, I
would agree. But there are plans to punish docs for things like
readmissions, or failure to get control over diabetes because of diet
failures, or problems with medication non-compliance that are not
entirely in the purview of the doc. THOSE are things I have qualms
about.


Well, whatever you call me, I am not ignoring that. But I have perhaps
another take on it. In my opinion, taxes and compulsory insurance should
not be subject to choice, whether with a religious fig leaf, or any other
fig leaf. It is generally not accepted when you are asked to pay taxes
to fund national security expenses.

But so far anyway, we aren't talking about things paid with taxes,
at least 100%. I don't think that religious organizations should be
required to pay for things that go against their religious beliefs.
National security is paid for 100% by taxes, so there is a difference.
Although I do remember quite a few people during VN and to a lesser
extent Iraq and Afghan, trying to withhold the %age of their taxes that
went to the Defense budget.


That seems awfully close to having a mandated low(ish) level of
compulsory insurance for everyone, with a choice of more insurance for an
additional premium.

Not awfully close. Dead on to what I am thinking.

And actually it is taxing policies that make the
employer pay for health insurance. I think it goes like this: The
employer is allowed a tax deduction for the premiums, which make it very
advantageous for both employer and employee. If there was no tax
deduction for the employer, he/she/it would have to pay an increased
salary, but that would make the extra income of the employee taxable.
Since that hits the more well-paid employee hardest, it is a certified
no-go!
Although rather late to the scene in my mind, health insurance
premiums are now deductible to the person.

In Mass, it was mostly successful. One of the problems was that the
costs of their system were (drum-roll, you'd never suspect this)
underestimated. I'm not sure whether it was overutilization by the
patients or increased use of tests etc by the doctors/hospitals. That
neatly confirms similar experiences in the Netherlands, but things there
are much more strict and simple than here.
The costs of the premiums went WAY up, too. There was a hefty number
of people who did not get insurance despite the mandate, but since the
insurers couldn't turn them down, they were still able to get insurance
when it was needed and then cut back again if the need went away.


That's another kettle of fish. I retired November 2010, and the employer
subsidized supplementary insurance for my wife and me was $106/mo. Now
it is $200/mo. And still the stock market isn't back to where it was in
2007. My home's assessed value went down 25%.

But when you invest over the 40+ years of working, *AND* the 25 or
30 years of retirement, you would be MUCH better off than what you are
getting with SS. Especially since an retirement account would require
reinvestment and you get the advantages of compounding interest.

I have had an IRA and put money into it every since they started. Even
at the worst of the downturn, the account was worth more than twice what
I had put into it over the years and I still had an annualized return of
around 7%. Even the trustees of SS note that about the best a person can
get is around 1% from their SS contribution and minorities have a
negative ROI since they tend to die earlier.

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

Kurt Ullman wrote in
:

In article ,
Han wrote:



Me neither, but if it is implemented prior to this information and
it
works out that it doesn't work, then good luck getting it
reversed.(g).

Well, there have been tests that bear on this. Your hospital and
doctors will perform better if they are forced (somehow) to wash
their hands more often. Surgery has fewer preventable bad outcomes,
if the use checklists to see what is left over at the end (all
scissors accounted for? All sponges?). Seems to me that incentives
to do the above plus penalties for those types of bad outcomes will
work.
For these things that are in the control of the professionals, I
would agree. But there are plans to punish docs for things like
readmissions, or failure to get control over diabetes because of diet
failures, or problems with medication non-compliance that are not
entirely in the purview of the doc. THOSE are things I have qualms
about.

True, but I doubt you can really punish doc if the patient keeps on
smoking ... Of course there is a grey area, and diabetes control isn't
easy, nor is control of INR (coumarin).

Well, whatever you call me, I am not ignoring that. But I have
perhaps another take on it. In my opinion, taxes and compulsory
insurance should not be subject to choice, whether with a religious
fig leaf, or any other fig leaf. It is generally not accepted when
you are asked to pay taxes to fund national security expenses.

But so far anyway, we aren't talking about things paid with taxes,
at least 100%. I don't think that religious organizations should be
required to pay for things that go against their religious beliefs.
National security is paid for 100% by taxes, so there is a difference.
Although I do remember quite a few people during VN and to a lesser
extent Iraq and Afghan, trying to withhold the %age of their taxes
that went to the Defense budget.

What I am trying to say is that if the law is indeed fully established
that you are required to buy insurance (through your employer or not),
then it becomes equivalent to a tax. And fftthh religion. There was,
once upon a time, a commandment thou shalt not kill, but since that was
established how many times has the church refused to fight a war? I
apologize if that hits some peoples sensibilities, but that is the summum
of hypocrisy IMNSHO. I guess I'm more against church/organized religion,
than against someone exercising their private religion, i.e., if you
don't want birth control for yourself, that's fine with me, and I do hope
you can bring up those children.

That seems awfully close to having a mandated low(ish) level of
compulsory insurance for everyone, with a choice of more insurance
for an additional premium.

Not awfully close. Dead on to what I am thinking.

And actually it is taxing policies that make the
employer pay for health insurance. I think it goes like this: The
employer is allowed a tax deduction for the premiums, which make it
very advantageous for both employer and employee. If there was no
tax deduction for the employer, he/she/it would have to pay an
increased salary, but that would make the extra income of the
employee taxable. Since that hits the more well-paid employee
hardest, it is a certified no-go!
Although rather late to the scene in my mind, health insurance
premiums are now deductible to the person.

I believe that is under the category of deductions that are over 5% or 7%
of AGI. That I never hope to reach, thank you. But I will have to look
into it very soon, as I had a few extra expenses this past year.

In Mass, it was mostly successful. One of the problems was that the
costs of their system were (drum-roll, you'd never suspect this)
underestimated. I'm not sure whether it was overutilization by the
patients or increased use of tests etc by the doctors/hospitals.
That neatly confirms similar experiences in the Netherlands, but
things there are much more strict and simple than here.
The costs of the premiums went WAY up, too. There was a hefty number
of people who did not get insurance despite the mandate, but since the
insurers couldn't turn them down, they were still able to get
insurance when it was needed and then cut back again if the need went
away.

I seemed to remember that a very high number of previously uninsured
became insured in Mass, more than expected.

That's another kettle of fish. I retired November 2010, and the
employer subsidized supplementary insurance for my wife and me was
$106/mo. Now it is $200/mo. And still the stock market isn't back
to where it was in 2007. My home's assessed value went down 25%.

But when you invest over the 40+ years of working, *AND* the 25 or
30 years of retirement, you would be MUCH better off than what you are
getting with SS. Especially since an retirement account would require
reinvestment and you get the advantages of compounding interest.

I have had an IRA and put money into it every since they started. Even
at the worst of the downturn, the account was worth more than twice
what I had put into it over the years and I still had an annualized
return of around 7%. Even the trustees of SS note that about the best
a person can get is around 1% from their SS contribution and
minorities have a negative ROI since they tend to die earlier.

Some of my "stuff" did reasonably well, other didn't. I'm pretty much OK
at the moment. SS is a weird form of insurance where your premiums pay
the claimants of the time, and you hope to get your claims paid when you
get up there. I never expected to get as much back as I put in, but
tht'll depend on how long I live, among other things. At the moment it
pays for somewhere around 1/3 of my retired expenses. (I don't have much
mortgage left, and a convenient small house where assessments suddenly
went down almost 25%. Don't know whether taxes will follow.

--
Best regards
Han
email address is invalid

"Robert Green" writes:

"Kurt Ullman" wrote in message
"Robert Green" wrote:
There WILL be death panels. There has to be death panels. BOTH sides
have studiously ignored that realilty and thrown up mutual smoke
screens.

I don't disagree. I believe (as I think Dan did) that the original "death
panels" were a deliberate mis-labeling of the concept of paying doctors to
advise patients about end-of-life care options. That got co-opted into
"there's a secret group of people conspiring to unplug Granny from the
respirator." As we both know there's ALWAYS been a secret group of people,
public and private, that determine resource allocation. The two concepts
got conflated, inflated, restated and distorted to death.

I believe my statement was that the ACA Death Panels as identified by SP
were nonsense.

Having some experience with this, the current situation is to work out
a plan between the doctor/patient/family.

At least that's what happened in our case with a family member after
a stroke. As long as that continues to work reasonably well, I don't
think we're going to need death panels.

Kurt's in the business (I think). Maybe he'll tell some stories.

--
Dan Espen

"Dan Espen" wrote in message
...
"Robert Green" writes:

"Kurt Ullman" wrote in message
"Robert Green" wrote:
There WILL be death panels. There has to be death panels. BOTH sides
have studiously ignored that realilty and thrown up mutual smoke
screens.

I don't disagree. I believe (as I think Dan did) that the original
"death
panels" were a deliberate mis-labeling of the concept of paying doctors
to
advise patients about end-of-life care options. That got co-opted into
"there's a secret group of people conspiring to unplug Granny from the
respirator." As we both know there's ALWAYS been a secret group of
people,
public and private, that determine resource allocation. The two
concepts
got conflated, inflated, restated and distorted to death.

I believe my statement was that the ACA Death Panels as identified by SP
were nonsense.

I should have double-checked. Sorry. Almost *anything* identified by SP
was nonsense. "I can almost see Russia." Geez. Can you imagine an American
Government textbook written by SP?

Having some experience with this, the current situation is to work out
a plan between the doctor/patient/family.

Sorry to hear that's necessary.

At least that's what happened in our case with a family member after
a stroke. As long as that continues to work reasonably well, I don't
think we're going to need death panels.

Kurt's in the business (I think). Maybe he'll tell some stories.

Kurt spurred my wife and me to see an eldercare attorney. The lawyer point
blank came out and said very early in the meeting that DNR's and other
end-of-life directives are incredibly easy to work around or outright
ignore, at least in my state. That didn't give me a warm and fuzzy feeling.
My wife's uncle had worked out every detail of his passing - how to avoid
the rapacious fees charged by some (most?) funeral homes, who was to get the
bulk of his estate, etc. Despite all that planning, life sat on him anyway
through a bizarre series of events coupled with a plan that lacked "depth."
His primary beneficiary died shortly after the funeral.

--
Bobby G.

"Han" wrote in message
...
Kurt Ullman wrote in
Han wrote:

stuff snipped

Well, there have been tests that bear on this. Your hospital and
doctors will perform better if they are forced (somehow) to wash
their hands more often. Surgery has fewer preventable bad outcomes,
if the use checklists to see what is left over at the end (all
scissors accounted for? All sponges?). Seems to me that incentives
to do the above plus penalties for those types of bad outcomes will
work.

For these things that are in the control of the professionals, I
would agree. But there are plans to punish docs for things like
readmissions, or failure to get control over diabetes because of diet
failures, or problems with medication non-compliance that are not
entirely in the purview of the doc. THOSE are things I have qualms
about.

True, but I doubt you can really punish doc if the patient keeps on
smoking ... Of course there is a grey area, and diabetes control isn't
easy, nor is control of INR (coumarin).

What? Are you seriously saying the government can't promulgate totally
stupid and senseless rules "just because." (-: Don't you mean coumadin?

Well, whatever you call me, I am not ignoring that. But I have
perhaps another take on it. In my opinion, taxes and compulsory
insurance should not be subject to choice, whether with a religious
fig leaf, or any other fig leaf. It is generally not accepted when
you are asked to pay taxes to fund national security expenses.

But so far anyway, we aren't talking about things paid with taxes,
at least 100%. I don't think that religious organizations should be
required to pay for things that go against their religious beliefs.
National security is paid for 100% by taxes, so there is a difference.
Although I do remember quite a few people during VN and to a lesser
extent Iraq and Afghan, trying to withhold the %age of their taxes
that went to the Defense budget.

I find it pretty clear that lots of people only want to pay taxes that fund
things they personally approve of and nothing else. That's a nice system of
taxation and representation if you can find it, but in the real world, we
all get stuck paying for things that don't benefit us directly, like the
childless paying school taxes.

What I am trying to say is that if the law is indeed fully established
that you are required to buy insurance (through your employer or not),
then it becomes equivalent to a tax. And fftthh religion. There was,
once upon a time, a commandment thou shalt not kill, but since that was
established how many times has the church refused to fight a war?

I tend to believe that it's hard core religious zealots that push for wars.
Then you have the whole perversity of fundamentalist Christians supporting
Israel because of their biblical place in the "end of days" mythology.
Historically, religion has resulted in horrific numbers of killings. My
ex-seminarian friend claims these deaths were offset by how the clergy
supported and improved the rights of serfs and common people during the
middle ages. I personally find it hard to square that sort of "mushy"
statistic with the Crusades, the Inquisition, the Thirty Years' War, the
Holocaust, etc. There's no doubt that religion's hands were never clean
when it comes to wars and probably never will be.

I apologize if that hits some peoples sensibilities, but that is the
summum
of hypocrisy IMNSHO. I guess I'm more against church/organized religion,
than against someone exercising their private religion, i.e., if you
don't want birth control for yourself, that's fine with me, and I do hope
you can bring up those children.

As my wife says, the Pro-life movement is mostly about older white religious
males without uteruses telling women what they can and can't do with theirs.
Abortion may be murder, but causing a child to be born into this world that
will neither be loved nor properly cared for is a pretty criminal act in my
eyes.

That seems awfully close to having a mandated low(ish) level of
compulsory insurance for everyone, with a choice of more insurance
for an additional premium.

Not awfully close. Dead on to what I am thinking.

And actually it is taxing policies that make the
employer pay for health insurance. I think it goes like this: The
employer is allowed a tax deduction for the premiums, which make it
very advantageous for both employer and employee. If there was no
tax deduction for the employer, he/she/it would have to pay an
increased salary, but that would make the extra income of the
employee taxable. Since that hits the more well-paid employee
hardest, it is a certified no-go!

Although rather late to the scene in my mind, health insurance
premiums are now deductible to the person.

I believe that is under the category of deductions that are over 5% or 7%
of AGI. That I never hope to reach, thank you. But I will have to look
into it very soon, as I had a few extra expenses this past year.

The deductions aren't very generous compared to what the Feds pay farmers
not to grow certain crops or oil companies to take greater risks. Maybe
that will change as we shift away from employer-sponsored health plans.
Like it or not, that process has been well underway for years as employers
continually scale back health benefits.

In Mass, it was mostly successful. One of the problems was that the
costs of their system were (drum-roll, you'd never suspect this)
underestimated. I'm not sure whether it was overutilization by the
patients or increased use of tests etc by the doctors/hospitals.
That neatly confirms similar experiences in the Netherlands, but
things there are much more strict and simple than here.

The costs of the premiums went WAY up, too. There was a hefty number
of people who did not get insurance despite the mandate, but since the
insurers couldn't turn them down, they were still able to get
insurance when it was needed and then cut back again if the need went
away.

I seemed to remember that a very high number of previously uninsured
became insured in Mass, more than expected.

You can never tell when a single state does something how many residents
from other states get into the act. In NYC, huge amounts of people from the
South and Puerto Rico moved there when the discovered how generous NYC's
welfare system was at the time. They've changed.

That's another kettle of fish. I retired November 2010, and the
employer subsidized supplementary insurance for my wife and me was
$106/mo. Now it is $200/mo. And still the stock market isn't back
to where it was in 2007. My home's assessed value went down 25%.

But when you invest over the 40+ years of working, *AND* the 25 or
30 years of retirement, you would be MUCH better off than what you are
getting with SS. Especially since an retirement account would require
reinvestment and you get the advantages of compounding interest.

I have had an IRA and put money into it every since they started. Even
at the worst of the downturn, the account was worth more than twice
what I had put into it over the years and I still had an annualized
return of around 7%. Even the trustees of SS note that about the best
a person can get is around 1% from their SS contribution and
minorities have a negative ROI since they tend to die earlier.

There's a catch, and it's an important one from what I've seen time and time
again. You can't cash out your SS earnings early the way you can an IRA.
I've seen plenty of people chew through their IRA's, taking a serious tax
penalty, too. When the shi+ hits the fan, some people just have nowhere
else to turn. I watched a good friend burn through his IRA due to health
problems. I let him "pawn" his rifle with me, partly because I thought he
was going to blow his brains out he was so depressed from illness and
"brokeness."

Some of my "stuff" did reasonably well, other didn't. I'm pretty much OK
at the moment. SS is a weird form of insurance where your premiums pay
the claimants of the time, and you hope to get your claims paid when you
get up there. I never expected to get as much back as I put in, but
tht'll depend on how long I live, among other things. At the moment it
pays for somewhere around 1/3 of my retired expenses. (I don't have much
mortgage left, and a convenient small house where assessments suddenly
went down almost 25%. Don't know whether taxes will follow.

Without a crystal ball, the future's always in doubt. I do know a lot of
elderly people that wouldn't be making it without SS and Medicare.

--
Bobby G.

"Han" wrote in message
...

stuff snipped

In Mass, it was mostly successful. One of the problems was that the
costs of their system were (drum-roll, you'd never suspect this)
underestimated. I'm not sure whether it was overutilization by the
patients or increased use of tests etc by the doctors/hospitals. That
neatly confirms similar experiences in the Netherlands, but things there
are much more strict and simple than here.

When I read about the problem both Massachusetts and Holland had, I began to
wonder why the cost estimates were so off. I suspect part of it could be
pent-up demand for services. When uninsured people first get to a doctor or
dentist, there's often more than one thing wrong with them. My wife tells me
that's unfortunately quite true of Army recruits from the really deep
boondocks. There's lots of snipping and such for them and even the Army's
equivalent of a good worming. More than a few have signs of poor nutrition.
She's told me how some of them were nearly speechless because they were able
to eat until they were full for the first time in their lives. We Internet
denizens often forget how lucky we are.

Also, sick and uninsured people from other states probably tend to gravitate
towards a state offering the plan Massachusetts did. I've been looking but
have yet to find any indication of how long people on the plan were
residents of the state. I know of one Pakistani who came here expecting
free medical treatment. I suspect there's a similar force operating at the
state level.

--
Bobby G.

In article ,
"Robert Green" wrote:

When I read about the problem both Massachusetts and Holland had, I began to
wonder why the cost estimates were so off. I suspect part of it could be
pent-up demand for services. When uninsured people first get to a doctor or
dentist, there's often more than one thing wrong with them. My wife tells me
that's unfortunately quite true of Army recruits from the really deep
boondocks. There's lots of snipping and such for them and even the Army's
equivalent of a good worming. More than a few have signs of poor nutrition.
She's told me how some of them were nearly speechless because they were able
to eat until they were full for the first time in their lives. We Internet
denizens often forget how lucky we are.

That might be an explanation if it was just the first couple of
years. MCare cost estimates are STILL off by multiple percentage points
even after all these years. I am torn between just bad models or people
deliberately trying to fudge the numbers (If the latter I am then torn
between directly fibbing or just a bureaucrat trying to give the boss
the numbers he or she wants).



Also, sick and uninsured people from other states probably tend to gravitate
towards a state offering the plan Massachusetts did. I've been looking but
have yet to find any indication of how long people on the plan were
residents of the state. I know of one Pakistani who came here expecting
free medical treatment. I suspect there's a similar force operating at the
state level.


Might be. There is ample evidence of people gravitating toward higher
food stamp and MCaid benefit states. But I see no census evidence of a
mass migration, we aren't talking about a few thousand here or there to
throw the numbers off by that much.

--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

"Kurt Ullman" wrote in message
m...
In article ,
"Robert Green" wrote:

When I read about the problem both Massachusetts and Holland had, I
began to
wonder why the cost estimates were so off. I suspect part of it could
be
pent-up demand for services. When uninsured people first get to a
doctor or
dentist, there's often more than one thing wrong with them. My wife
tells me
that's unfortunately quite true of Army recruits from the really deep
boondocks. There's lots of snipping and such for them and even the
Army's
equivalent of a good worming. More than a few have signs of poor
nutrition.
She's told me how some of them were nearly speechless because they were
able
to eat until they were full for the first time in their lives. We
Internet
denizens often forget how lucky we are.

That might be an explanation if it was just the first couple of
years. MCare cost estimates are STILL off by multiple percentage points
even after all these years. I am torn between just bad models or people
deliberately trying to fudge the numbers (If the latter I am then torn
between directly fibbing or just a bureaucrat trying to give the boss
the numbers he or she wants).

Bureaucrats lie to make a weak program stronger? Where do you get these
outrageous ideas!? (tongue firmly in cheek)


Also, sick and uninsured people from other states probably tend to
gravitate
towards a state offering the plan Massachusetts did. I've been looking
but
have yet to find any indication of how long people on the plan were
residents of the state. I know of one Pakistani who came here expecting
free medical treatment. I suspect there's a similar force operating at
the
state level.


Might be. There is ample evidence of people gravitating toward higher
food stamp and MCaid benefit states. But I see no census evidence of a
mass migration, we aren't talking about a few thousand here or there to
throw the numbers off by that much.

Where did you find any census information at all? I didn't see much when I
looked.

--
Bobby G.

"Robert Green" wrote in news:jj6fe0$sdv$1
@speranza.aioe.org:

What? Are you seriously saying the government can't promulgate totally
stupid and senseless rules "just because." (-:

Smile

Don't you mean coumadin?

Coumadin is a tradename, just like Warfarin, coumarin is the name for the
compound. I have expounded before on the origin of its discovery, and the
name Warfarin: Wisconsin Alumni Research Foundation.


--
Best regards
Han
email address is invalid

"Robert Green" wrote in
:

"Dan Espen" wrote in message
...
"Robert Green" writes:

"Kurt Ullman" wrote in message
"Robert Green" wrote:
There WILL be death panels. There has to be death panels. BOTH
sides
have studiously ignored that realilty and thrown up mutual smoke
screens.

I don't disagree. I believe (as I think Dan did) that the original
"death
panels" were a deliberate mis-labeling of the concept of paying
doctors
to
advise patients about end-of-life care options. That got co-opted
into "there's a secret group of people conspiring to unplug Granny
from the respirator." As we both know there's ALWAYS been a secret
group of
people,
public and private, that determine resource allocation. The two
concepts
got conflated, inflated, restated and distorted to death.

I believe my statement was that the ACA Death Panels as identified by
SP were nonsense.

I should have double-checked. Sorry. Almost *anything* identified by
SP was nonsense. "I can almost see Russia." Geez. Can you imagine an
American Government textbook written by SP?

Having some experience with this, the current situation is to work
out a plan between the doctor/patient/family.

Sorry to hear that's necessary.

At least that's what happened in our case with a family member after
a stroke. As long as that continues to work reasonably well, I don't
think we're going to need death panels.

Kurt's in the business (I think). Maybe he'll tell some stories.

Kurt spurred my wife and me to see an eldercare attorney. The lawyer
point blank came out and said very early in the meeting that DNR's and
other end-of-life directives are incredibly easy to work around or
outright ignore, at least in my state. That didn't give me a warm and
fuzzy feeling. My wife's uncle had worked out every detail of his
passing - how to avoid the rapacious fees charged by some (most?)
funeral homes, who was to get the bulk of his estate, etc. Despite
all that planning, life sat on him anyway through a bizarre series of
events coupled with a plan that lacked "depth." His primary
beneficiary died shortly after the funeral.

--
Bobby G.

That is all the more reason to appoint a durable power of attorney for
healthcare for someone you trust.

--
Best regards
Han
email address is invalid

"Han" wrote in message
...

stuff snipped

Kurt spurred my wife and me to see an eldercare attorney. The lawyer
point blank came out and said very early in the meeting that DNR's and
other end-of-life directives are incredibly easy to work around or
outright ignore, at least in my state. That didn't give me a warm and
fuzzy feeling. My wife's uncle had worked out every detail of his
passing - how to avoid the rapacious fees charged by some (most?)
funeral homes, who was to get the bulk of his estate, etc. Despite
all that planning, life sat on him anyway through a bizarre series of
events coupled with a plan that lacked "depth." His primary
beneficiary died shortly after the funeral.

That is all the more reason to appoint a durable power of attorney for
healthcare for someone you trust.

Name three people that you'd trust with your life. (-:

I know a DPoA (and other estate documents) are a good idea but I've already
discovered that if you're contesting a living will or power of attorney
against a relative that sits on the bench, you're going to lose. Very few
attorneys I know of like to litigate against judges they may someday appear
in front of. Judges pretty much assume an application from another judge is
automatically correct. I'm in a special, ugly case that I'd rather not
describe concerning what some relatives feel was an unequal estate
distribution. That's why I know about "If you contest this will" clauses
that give enough money to potential contestants that it's better for them to
take it than risk the enforcement of a clause that says contestants to the
will are disinherited.

My orthopedic surgeon and his ER nurse wife had reciprocal PoA's and he was
killed and she brain damaged in a horrific crash during an icestorm. Like
my wife's uncle, these were both highly educated people that didn't plan
enough moves ahead. Both cases were exacerbated by long-simmering familial
ill-will as well. But that's not at all uncommon when someone is seriously
ill, injured or dying. Very stressful times. That's why I agree it's nice
to have documents that spell out last wishes thoroughly. But not everyone
cares about or honors those. Doctors fear some greedy relative has forged a
DNR to hasten their inheritance, too.

Remarkably, my neighbor, who dropped out of high school, assembled a pretty
impressive financial and legal "what if I get sick or die?" setup using a
Suzie Orman self-help program. I can't stand to listen to SO for more than
three seconds in a row, but I must admit she did a good job on making estate
planning accessible for someone like my neighbor - bright, blue collar
single mom. Doing it yourself and then having a lawyer review provides a
much better understanding of the situation, IMHO.

One thing I've found to be a recurring problem. People set things like this
up with their contemporaries many times when they should be setting them up
with someone much younger and not likely to be decrepit in some way when the
documents are executed. We're done to my god daughter and my wife's neice
and may end up making them the fallbacks in case we're both incapacitated
simultaneously. It's pretty freaky to start planning for your own death or
decrepitude. )-:

--
Bobby G.

"Robert Green" wrote in
:

"Han" wrote in message
...

stuff snipped

Kurt spurred my wife and me to see an eldercare attorney. The
lawyer point blank came out and said very early in the meeting that
DNR's and other end-of-life directives are incredibly easy to work
around or outright ignore, at least in my state. That didn't give
me a warm and fuzzy feeling. My wife's uncle had worked out every
detail of his passing - how to avoid the rapacious fees charged by
some (most?) funeral homes, who was to get the bulk of his estate,
etc. Despite all that planning, life sat on him anyway through a
bizarre series of events coupled with a plan that lacked "depth."
His primary beneficiary died shortly after the funeral.

That is all the more reason to appoint a durable power of attorney
for healthcare for someone you trust.

Name three people that you'd trust with your life. (-:

I know a DPoA (and other estate documents) are a good idea but I've
already discovered that if you're contesting a living will or power of
attorney against a relative that sits on the bench, you're going to
lose. Very few attorneys I know of like to litigate against judges
they may someday appear in front of. Judges pretty much assume an
application from another judge is automatically correct. I'm in a
special, ugly case that I'd rather not describe concerning what some
relatives feel was an unequal estate distribution. That's why I know
about "If you contest this will" clauses that give enough money to
potential contestants that it's better for them to take it than risk
the enforcement of a clause that says contestants to the will are
disinherited.

My orthopedic surgeon and his ER nurse wife had reciprocal PoA's and
he was killed and she brain damaged in a horrific crash during an
icestorm. Like my wife's uncle, these were both highly educated
people that didn't plan enough moves ahead. Both cases were
exacerbated by long-simmering familial ill-will as well. But that's
not at all uncommon when someone is seriously ill, injured or dying.
Very stressful times. That's why I agree it's nice to have documents
that spell out last wishes thoroughly. But not everyone cares about
or honors those. Doctors fear some greedy relative has forged a DNR
to hasten their inheritance, too.

Remarkably, my neighbor, who dropped out of high school, assembled a
pretty impressive financial and legal "what if I get sick or die?"
setup using a Suzie Orman self-help program. I can't stand to listen
to SO for more than three seconds in a row, but I must admit she did a
good job on making estate planning accessible for someone like my
neighbor - bright, blue collar single mom. Doing it yourself and then
having a lawyer review provides a much better understanding of the
situation, IMHO.

One thing I've found to be a recurring problem. People set things
like this up with their contemporaries many times when they should be
setting them up with someone much younger and not likely to be
decrepit in some way when the documents are executed. We're done to
my god daughter and my wife's neice and may end up making them the
fallbacks in case we're both incapacitated simultaneously. It's
pretty freaky to start planning for your own death or decrepitude.
)-:

--
Bobby G.

You're probably right to say you can't trust anyone. SMIRK. That's why
I have talked about this to anyone who would care to listen and then
some. If it isn't clear to anyone what I'd want, they are either senile
or crazy. But I can appreciate the bind you are in ...


--
Best regards
Han
email address is invalid

In article ,
"Robert Green" wrote:

"Han" wrote in message
...

stuff snipped

Kurt spurred my wife and me to see an eldercare attorney. The lawyer
point blank came out and said very early in the meeting that DNR's and
other end-of-life directives are incredibly easy to work around or
outright ignore, at least in my state. That didn't give me a warm and
fuzzy feeling. My wife's uncle had worked out every detail of his
passing - how to avoid the rapacious fees charged by some (most?)
funeral homes, who was to get the bulk of his estate, etc. Despite
all that planning, life sat on him anyway through a bizarre series of
events coupled with a plan that lacked "depth." His primary
beneficiary died shortly after the funeral.

That is all the more reason to appoint a durable power of attorney for
healthcare for someone you trust.

Name three people that you'd trust with your life. (-:

That isn't the problem anyway. It is not terribly rare that, even when
there is durable power of attorney, the wishes of the person as conveyed
by the person with the power of attorney is ignored. If someone else in
the family is making enough noise, the docs may often go with the noisy
one because that is where the legal issues can arise. Most states that I
am aware of, give little protection to the doc from others even if there
is a DPoA. The DPoA really gives it best protection against the doc who
doesn't like to have people mess with his or her save stats.



--
People thought cybersex was a safe alternative,
until patients started presenting with sexually
acquired carpal tunnel syndrome.-Howard Berkowitz

Kurt Ullman wrote in
m:

In article ,
"Robert Green" wrote:

"Han" wrote in message
...

stuff snipped

Kurt spurred my wife and me to see an eldercare attorney. The
lawyer point blank came out and said very early in the meeting
that DNR's and other end-of-life directives are incredibly easy
to work around or outright ignore, at least in my state. That
didn't give me a warm and fuzzy feeling. My wife's uncle had
worked out every detail of his passing - how to avoid the
rapacious fees charged by some (most?) funeral homes, who was to
get the bulk of his estate, etc. Despite all that planning, life
sat on him anyway through a bizarre series of events coupled with
a plan that lacked "depth." His primary beneficiary died shortly
after the funeral.

That is all the more reason to appoint a durable power of attorney
for healthcare for someone you trust.

Name three people that you'd trust with your life. (-:

That isn't the problem anyway. It is not terribly rare that, even
when
there is durable power of attorney, the wishes of the person as
conveyed by the person with the power of attorney is ignored. If
someone else in the family is making enough noise, the docs may often
go with the noisy one because that is where the legal issues can
arise. Most states that I am aware of, give little protection to the
doc from others even if there is a DPoA. The DPoA really gives it best
protection against the doc who doesn't like to have people mess with
his or her save stats.

It is best to surround yourself with people of like thoughts to yourself.
I'm lucky in that respect, since even the relatives I have acquired
through the marriage of my daughter, and who are rather much more to the
right politically and religionwise compared to me, are thinking the same
as I am with respect to end of life questions. And believe me, I know
from personal experience how difficult those questions are when they
(need to) impact your loved ones.

--
Best regards
Han
email address is invalid

On Wed, 07 Mar 2012 02:02:07 -0500, Kurt Ullman wrote:

In article ,
"Robert Green" wrote:

When I read about the problem both Massachusetts and Holland had, I began to
wonder why the cost estimates were so off. I suspect part of it could be
pent-up demand for services. When uninsured people first get to a doctor or
dentist, there's often more than one thing wrong with them. My wife tells me
that's unfortunately quite true of Army recruits from the really deep
boondocks. There's lots of snipping and such for them and even the Army's
equivalent of a good worming. More than a few have signs of poor nutrition.
She's told me how some of them were nearly speechless because they were able
to eat until they were full for the first time in their lives. We Internet
denizens often forget how lucky we are.

That might be an explanation if it was just the first couple of
years. MCare cost estimates are STILL off by multiple percentage points
even after all these years. I am torn between just bad models or people
deliberately trying to fudge the numbers (If the latter I am then torn
between directly fibbing or just a bureaucrat trying to give the boss
the numbers he or she wants).

There is no difference. A lie is a lie, whether the boss demands the lie or
not. Politicians want single-payer *insurance* and will bring the entire
health *care* system down to get it.

Also, sick and uninsured people from other states probably tend to gravitate
towards a state offering the plan Massachusetts did. I've been looking but
have yet to find any indication of how long people on the plan were
residents of the state. I know of one Pakistani who came here expecting
free medical treatment. I suspect there's a similar force operating at the
state level.


Might be. There is ample evidence of people gravitating toward higher
food stamp and MCaid benefit states. But I see no census evidence of a
mass migration, we aren't talking about a few thousand here or there to
throw the numbers off by that much.

There is a mass migration to right-to-work states, however.

"Kurt Ullman" wrote in message
m...
In article ,
"Robert Green" wrote:

"Han" wrote in message
...

stuff snipped

Kurt spurred my wife and me to see an eldercare attorney. The
lawyer
point blank came out and said very early in the meeting that DNR's
and
other end-of-life directives are incredibly easy to work around or
outright ignore, at least in my state. That didn't give me a warm
and
fuzzy feeling. My wife's uncle had worked out every detail of his
passing - how to avoid the rapacious fees charged by some (most?)
funeral homes, who was to get the bulk of his estate, etc. Despite
all that planning, life sat on him anyway through a bizarre series
of
events coupled with a plan that lacked "depth." His primary
beneficiary died shortly after the funeral.

That is all the more reason to appoint a durable power of attorney for
healthcare for someone you trust.

Name three people that you'd trust with your life. (-:

That isn't the problem anyway. It is not terribly rare that, even when
there is durable power of attorney, the wishes of the person as conveyed
by the person with the power of attorney is ignored. If someone else in
the family is making enough noise, the docs may often go with the noisy
one because that is where the legal issues can arise. Most states that I
am aware of, give little protection to the doc from others even if there
is a DPoA. The DPoA really gives it best protection against the doc who
doesn't like to have people mess with his or her save stats.

Bingo. That was my experience. The squeaky wheel gets the grease. I
would say that the system is designed so that any opposition can cause a
failure to follow the DPoA. Doctors, in my experience will choose the path
that causes them the least legal exposure. That only makes sense. The
issue is often complicated by the fact the person who's sustained the legal
injury is dying and not in a good position to sue. They're good documents
to have, but people shouldn't be surprised to come out of a three year coma
with their DPoA long dishonored. In that case, they might not even care if
they were cured!

--
Bobby G.