Althouse: Should smokers be denied a heart bypass? Should the obese be denied hip replacements?

January 27, 2008

Should smokers be denied a heart bypass? Should the obese be denied hip replacements?

Everyone can't get everything, can they, if the government is paying?

(Via Memeorandum.)

36 comments:

Bob said...: Should rich drug abusers (David Crosby) be able to purchase new livers, jumping the line on transplants?

It's all part and parcel of the same problem, and only a matter of time until the solution that Sci-Fi writer Larry Niven envisioned decades ago is instituted: harvesting of organs of condemned criminals, and the death penalty expanded to meet the need for organs.; 1/27/08, 8:44 AM
Kev said...: Take notes - this will be us in a few years at the rate we are socializing medicine. Next people will be denied medical care based on their 'unhealthy politics.'; 1/27/08, 8:44 AM
Swifty Quick said...: As PJ O'Rourke said, if you think health care is expensive now, just wait until it's free. When the government is in charge of giving it away it will have to be rationed. The government will decide who and who does not gets what.; 1/27/08, 8:52 AM
George M. Spencer said...: This comment has been removed by the author.; 1/27/08, 9:18 AM
George M. Spencer said...: Here is the future...

Excellent quality of care...convenient (sort of)..and inexpensive...

"For uninsured or under-insured patients from the United States, procedures in Singapore cost one-fifth or less of the price back home. This is similar to costs at other major Asian medical travel destinations. Even after factoring in the patient's and accompanying persons' travel and accommodation expenses, the cost savings are still considerable. On top of the affordability, patients in Singapore are assured of world-class treatment and good clinical outcomes."

Singaporemedicine.com; 1/27/08, 9:20 AM
save_the_rustbelt said...: Obese patients are denied hip replacement surgery because of a
higher probability of complications (fat emboli) and because of difficulties with physical therapy and rehab.

Trust, US surgeons want to do more surgery. What they don't want is to have post-op patients in ICU.; 1/27/08, 9:30 AM
save_the_rustbelt said...: I messed up my first paragraph, not enough coffee yet.

In the UK care may be denied for either financial or clinical purposes, or a combination. Obese patients bring much higher risks to many surgeries.; 1/27/08, 9:33 AM
Dust Bunny Queen said...: Can Soylent Green be far behind.

Oh brave new world.

The law of unintended consequences once again rears its ugly head.; 1/27/08, 9:47 AM
Anonymous said...: Whoever is paying the bills gets to make the rules. (And no, I don't approve.); 1/27/08, 9:48 AM
rcocean said...: How would they know you're a smoker, unless you told them? Isn't it an incentive to lie about your medical history?; 1/27/08, 9:50 AM
KCFleming said...: How would they know you're a smoker?
Laboratory tests can measure cotinine levels, a chemical made by metabolizing nicotine from cigarette smoke. It can be detected in blood, urine, or saliva.

It would require stopping smoking from 7 to 10 days before levels drop to zero.

Once the government is paying the bills they will demand you submit to numerous tests and protocols to save their money.

You will no longer own your own body. The collective will own it. In England, they are proposing presumed organ donor status for all citizens who die. You cannot refuse, because they own it, not you.; 1/27/08, 10:13 AM
rhhardin said...: Odd and even social security numbers ought to take care of rationing.; 1/27/08, 10:31 AM
former law student said...: Doctors are making those very same decisions now, in our fabulous pay-for-service medical system. Someone like Ann, over 55 with grown children, would be well down on any transplant list.; 1/27/08, 10:59 AM
KCFleming said...: Doctors are making those very same decisions now

Wrong. There is rationing for liver transplants, but alcohol abuse is only a factor if they are currently using.

Smokers are not denied care in the same way described in the article, or even at all that I am aware of. Their procedures may be deferred until they have stopped smoking, but not indefinitely, just a few weeks. The fat are refused only those surgeries that cannot survive.

FLS, you are completely, utterly wrong about this.; 1/27/08, 11:06 AM
Beta Conservative said...: Should criminals be denied expensive medical care based on their enormous cost to society? How about people who squander hundreds of thousands of dolars of public investment in their education only to drop out and have or make babies when they're 15 or 16?

Whe gets to decide who is worthy, and why single out smokers or the overweight as the only two groups that burden society and tax rolls?; 1/27/08, 11:15 AM
Fen said...: Next people will be denied medical care based on their 'unhealthy politics.'

Except for women who accept the 1% risk that their birth control will fail. We need sex so bad we're willing to kill a baby for it. And our government will continue to enbable us.; 1/27/08, 11:26 AM
Anonymous said...: Or the Canadian woman I saw on an HGTV show who was selling her house to get treatment for her 4-yr-old autistic son. He was put on the waiting list but there are so many kids on the waiting list she figured he would be eventually be disqualified for age, as govt treatment stops at age 6.

"We are the government, and we are here to help."

Yes, this is our future. Save your money for those future procedures in India.; 1/27/08, 11:32 AM
Fen said...: Pogo: You will no longer own your own body. The collective will own it.

It Could Happen Tomorrow:

"Canadian authorities have taken former blogger Mark Steyn into custody, claiming he violated the restrictions in his plea agreement. Last year, MiniSci determined that Steyn's diatribes were the root cause of his heart condition, and ordered him to stop expressing his political beliefs in public".

/obvious sarcasm tag, because Steyn would never make a plea agreement with the Speech Code Courts in Canada.; 1/27/08, 11:35 AM
Fen said...: uhm, if the government is going to paying for our health care, shouldn't they do genetic testing and pass that info along to the Insurance industry? I don't want my tax dollars going to people who make bad genetic choices [Recessives]; 1/27/08, 11:40 AM
Fen said...: Also, is it a "hate crime" for me to refer to the genetically inferior as Recessives? Guess I better flee to Canada - oh wait...

If you liked Gatica, you'll love Socialized Health Care; 1/27/08, 11:52 AM
Simon said...: Bob said...
"It's all part and parcel of the same problem, and only a matter of time until the solution that Sci-Fi writer Larry Niven envisioned decades ago is instituted: harvesting of organs of condemned criminals, and the death penalty expanded to meet the need for organs."

That's part of the concern I have about embryonic stem cell research - despite protests about the sources of lines today, you have to look to the future. If it produced a treatment that was very effective and could only be made from embryonic stem cells, you set up a demand that would be met - one way or another. This sort of thing has been a scifi staple for years; Babylon 5 covered it very effectively in the episode Deathwalker, IIRC.; 1/27/08, 12:14 PM
Christy said...: The heart surgeon, checking in with Dad before his by-pass surgery, told him surgery wouldn't do any good unless Dad stopped smoking. Dad immediately fired the surgeon and waited another day for his surgeon of choice.

I don't necessarily disagree about the use of cost/benefit analysis in determining who gets limited public money for treatment.; 1/27/08, 2:18 PM
Peter V. Bella said...: This may be the best thing in the world.

For lawyers.; 1/27/08, 2:42 PM
Peter V. Bella said...: Jim said:
why single out smokers or the overweight as the only two groups that burden society and tax rolls?

Because "progressives" determine who is evil in our society. Right now it is the fat and the smoker. Next it will be those who are in high risk positions, then they will go after...

It is just what the progressives want to do with Social Security. The Democrats started raising the retirement age. If they get their way, the retirement age will be death. Then they can keep your money.; 1/27/08, 2:46 PM
knox said...: For lawyers.

It's my understanding that in Canada, at least, you are not allowed to sue the government health system. So there are *zero* consequences if they kill somebody by making them wait for treatment, or any other reason. And no big winnings for lawyers.; 1/27/08, 3:38 PM
Beta Conservative said...: Will those who damage their health by engaging in repeated, risky sexual behavior, gay or straight, be denied expensive treatments because they are after all victims of their own actions?

Who are the deciders on medical sanctioning?; 1/27/08, 3:47 PM
Elliott A said...: Is it wrong to ask the people who are the beneficiaries of other peoples tax dollars to demonstrate appropriate behavior before those aforementioned taxpayers pay for medical treatment? My wife works with Diabetics. Most are totally unwilling to give up their sedentary 4000 calorie a day lifestyle. These people are like vacuums for health care dollars. Now that these dollars are no longer an infinite resource, something has to give.; 1/27/08, 5:40 PM
opinionator said...: Yes, smokers should be denied a heart bypass. These individuals have compromised lungs from smoking, thereby making anesthesia more problematic. Their vascular system is compromised, making them harder to heal. Smokers are a huge risk for any surgical procedure, period. Enough said.

Yes, the obese should be denied hip replacements. Lose the weight and we will talk. The hip prosthesis will not last very long in bones that already compromised by the fat to which they subjected their hip joints. Better that we pay for a lap band than have to repeatedly treat them for joint replacements.

And no, we shouldn't keep paying for individuals to have organ transplants because they can't manage to take their medications or do the same risky behavior that caused some individual's need for a transplant.; 1/27/08, 5:51 PM
opinionator said...: Pogo:

Yes, there are certain procedures that are being denied because the patient is a smoker. Neurosurgeons frequently refuse to operate on spines of smokers; simply because the bones of smokers do not heal as well as non-smokers. And yes, there are very accurate tests for nicotine. There are patients who have been denied their surgery the night before it was scheduled.; 1/27/08, 5:54 PM
Peter V. Bella said...: Jim said...
Will those who damage their health by engaging in repeated, risky sexual behavior, gay or straight, be denied expensive treatments because they are after all victims of their own actions?

Who are the deciders on medical sanctioning?

How about those who put illegal and dangerous drugs into their systems? Junkies, coke heads, crack heads, etc.? Should we keep paying for their rehab over and over again? Should we pay for the problems they caused themselves?

The question is who in the hell is going to play God and tell you you cannot have medical treatment to save your life? Are we going to turn into a puritan country that says live as I do or die?

Universal health care is not called universal death care for nothing.; 1/27/08, 6:23 PM
Unknown said...: It is outrageous for doctors to make any such decision on any ground other than the likely success of the procedure. Doctors are ethically forbidden from denying treatment to patients on the basis of agreement with their habits. As I tell my students, "If Jeffrey Dahmer comes to you with indigestion, treat him no batter what he ate for lunch."

On the other hand, it is reasonable to turn a patient down for a procedure if the risks exceed the benefits, even if the risk is patient-induced. And a system can make cost-benefit judgments.

But what if the patient has a politically correct condition that reduces chances of successful treatment-- say, HIV instead of smoking?; 1/27/08, 6:49 PM
knox said...: what he ate for lunch

or who; 1/27/08, 9:54 PM
knox said...: risky behavior

Doctors/researchers can't even decide what behavior is actually risky. Wasn't that long ago we were being told to eschew butter for trans-fats and carbs were at the base of the food pyramid.

My husband's grandfather smoked from age 14 and lived into his 80s. Under universal healthcare anyone could have used the "risky" argument and set his expiration date somewhere around 60.; 1/27/08, 10:07 PM
Michael The Magnificent said...: When I went through cardiac rehab, I asked the nurses about repeat customers, in regards to smoking, because I had just quit.

If they are to be believed, the smokers who don't quit - and manage to survive their next heart attack - make up the bulk of their repeat customers. I was told that they rarely see a repeat customer who had successfully quit smoking the first time.

Standard Disclaimer; 1/27/08, 11:08 PM
KCFleming said...: Neurosurgeons frequently refuse to operate on spines of smokers

That is very different than the the state mandating that refusal.

Choice is the key.
State-controlled health care removes meaningful choice, inserting their own, and their values, above yours.

For example, what of these rules in the case where a 78 year old female smoker who comes to the ER in extremis from a heart attack, needing emergency bypass to save her life.

Too bad, lady?
Too bad you "paid into" national health care your whole life under the presumption you'd be cared for when it was your turn, but they changed the rules when it was your turn?

What a joke.; 1/28/08, 6:34 AM
Daryl said...: Pogo wrote: Too bad you "paid into" national health care your whole life under the presumption you'd be cared for when it was your turn, but they changed the rules when it was your turn?

It's the "Flounder Principle":

you fucked up--you trusted us!

We need a new rule: if you want to live forever, pay for it out of your own pocket. After 75, we should impose a strict ceiling on government-paid-for medical expenses.

Of course, all of the grandfathers out there should be grandfathered in. Nobody currently over 50 should have their care curtailed.

And we should encourage smoking. Smoke, smoke, smoke, and die young. Our nation can afford, contrary to the liberal lies, people dying at 60 of lung cancer. That's extremely affordable. People who smoke are doing the rest of us a favor and we should acknowledge it, first and foremost by repealing all special tobacco taxes.

I will say this, though: I don't feel any sort of obligation to old people (Boomers) based on the fact that they may have relied on the existing system. They were responsible for the existing system. They chose it, not me. Now they want to make it out as some sacred cow surrounded by third rails.

They selfishly enacted a system that benefited themselves at our expense, and resisted making changes when it was clear the system was headed for crisis. Now they want to lay a guilt trip on us? Screw them. We should raid rich Boomers' retirement accounts to pay for all of the medical care they are demanding for their poor fellow-Boomers. Their generation fucked up, not mine. Generations should pay for themselves instead of sucking the lifeblood out of the next generation.; 1/29/08, 6:33 PM