'Too Old' for Hip Surgery

[question everything]

Yes, it is inflammatory, from the WSJ, and very biased. However, like "Harry and Louise" from 1994, it can persuade most Americans, who still have employer-provided health insurance, to express their opposition to a universal health care, an opposition on which Republicans can plan their 2010 campaign.


FEBRUARY 9, 2009

'Too Old' for Hip Surgery
By NADEEM ESMAIL
WSJ

President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of Schip -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience. Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting. Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.

In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor. Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.


Shona Holmes, another Ontario court challenger, endured a similarly harrowing struggle. In March of 2005, Ms. Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests along with more wait times. Ms. Holmes returned to the Mayo Clinic and paid for her surgery.

On the other side of the country in Alberta, Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state-of-the-art procedure that gives better results than basic hip replacement) as the best medical option. But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no. In the end, he was also denied the opportunity to pay for the procedure himself in Alberta. He's heading to court claiming a violation of Charter rights as well.

(snip)


The experiences of these Canadians -- along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 -- show how miserable things can get when government is put in charge of managing health insurance. In the wake of the 2005 ruling, Canada's federal and provincial governments have tried unsuccessfully to fix the long wait times by introducing selective benchmarks and guarantees along with large increases in funding. The benchmarks and the guarantees aren't ambitious: four to eight weeks for radiation therapy; 16 to 26 weeks for cataract surgery; 26 weeks for hip and knee replacements and lower-urgency cardiac bypass surgery.

(snip)

Mr. Esmail, based in Calgary, is the director of Health System Performance Studies at The Fraser Institute.

http://online.wsj.com/article/SB123413701032661445.html

[MADem]

1. 57 is too old? Don't tell my eighty five year old relative who had the operation last year.

Doing very well, too.

[Bobbieo]

5. I have had both hips and a knee replaced since 1994 when I was 71 years of age.

[Tangerine LaBamba]

8. You're 85?

Hey, rock on, baby!!!!!

:toast:

[MADem]

10. There ya go--you'd probably be in a wheelchair racked with pain otherwise.

Ya doing ok with the replacements?

[pipi_k]

17. My MIL had hip surgery when she was in her late 80s and then again

when she was 93.

Although with the first one she got almost immediate surgery but with the second she had to wait three or four days before they would operate.



PS...I'm glad your relative is doing well after surgery. Mom did well the first time too, but after the second, she just barely lived to the six months prognosis for elderly people who break their hips.

[question everything]

20. And we will be faced with these questions if and when we will have

a universal health care. It is already known that for many people, most of their medical expenses occur in the last year of their lives. I knew a woman who was a diabetic and a smoker who, at the agoe of 85, had a heart bypass surgery. A few months later she died from complications, or a stroke, I don't remember. Will people like that be candidates for such surgeries? Will tax payers "demand" some sort of ratios? What about liver transplant for heavy drinkers? How much heroic measures for long time smokers? And obese people?

Such people already are being harassed by employers, even fired. How will they be treated by tax payers?

[MADem]

25. They're doing some amazing things with those procedures.

They've gotten better and better with it, with practice, I guess, like everything.

I have another relative who's rather bionic--hips, knees, and shoulder--and she recovers, rather amazingly, after each procedure without hardly any difficulty--she doesn't take much pain medication either, because it makes her "sick" so she says. She's in her mid eighties, too. Still drives all over hell, goes on vacations, tells everyone how to live their lives, and is a general pain in the ass when she doesn't get her way!

Perhaps that is the secret...the pain in the ass thing!

[Mayberry Machiavelli]

32. Surgery for broken hip is completely different situation than for arthritis.

The surgeries are different as well as the urgency of doing it.

[CHIMO]

2. Right On

The Fraser Intsitute:
Right on Target

An Institution



The Fraser Institute was founded by Michael Walker in 1974 and quickly gained a comical reputation for its extreme right-wing views. Commonly dismissed as a �right-wing think- tank,� they initially had no visible impact on public opinion until recent years, as the political climate has changed. With the increasing corporate control of Canada�s news media, and the populace in a frenzy over a spectre called The Deficit, the Fraser Institute�s agenda to promote a totally free-market system is gaining greater approval as it reaches a wider audience. Their campaigns have become increasingly complex and their image has been modified from frothing neo-conservative cultists, to an organization of (self-appointed) �experts� with something to say about most current issues: from unemployment, to the environment, to the free trade agreements. The Institute has become adept at making arguments couched in seemingly rational, objective phrases, but upon closer analysis, the solutions they offer are clearly inconsistent, and in many cases, Victorian.

It all began in �74 when Walker, a right-wing economist from the University of Western Ontario, received financial backing from forestry giant MacMillan-Bloedel, largely to counter the elected NDP provincial government of Dave Barrett. Thus was the Fraser Institute spawned. Mac-Blo was soon joined by a host of other corporate sponsors, which, by the mid-1980�s, included the Power Corporation, Southam Inc., Thomson Newspapers, The Molson Companies, BC Timber, Dow Chemical, Dupont, Imperial Oil, Proctor and Gamble, Canadian Tire, BC-TEL, Bell Canada, Boise-Cascade, Kraft Foods, the banks of Nova Scotia, Montreal, Royal Bank, Toronto Dominion Bank, CIBC, Wood Gundy Ltd., McDonalds and Irwin Toys. With such powerful friends as these providing 40% of the Institute�s annual budget (over $2 million), the FI was well on its way to public prominence. Today they have offices in Toronto and Seattle, and headquarters in Vancouver.

The FI has an open mandate to �redirect attention to the use of competitive markets as the best mechanism for responding to change.� This boils down to a philosophy in which an entirely free market system is the best solution to society�s ills, no matter what those may be, and the FI has gone to great lengths to promote this view in many different contexts. It is a view (admittedly) derived from Adam Smith�s economic theories of the 1700�s.

http://www.peak.sfu.ca/the-peak/95-2/issue13/fraser8.html

Some things just won't ever die. Well maybe.

[Hannah Bell]

4. They never let up. They won't be happy until everyone is malnourished & propertyless.

They can skim off the strongest ones to do the work & let the rest die, & drink cocktails on their estates, like proper lords of the universe.

[catnhatnh]

3. So I googles Old Nadeem and shock of shocks!!!!

He's tied up with the Fraser Institute....a little more google action and voila: http://en.wikipedia.org/wiki/Fraser_Institute

Case closed.

[BrklynLiberal]

6. But they never put that stuff into the mini bio at the end of the article...

[Tangerine LaBamba]

7. I just did the google

on The Fraser Institute.

http://www.sourcewatch.org/index.php?title=Fraser_Institute

Rightwingnuts.

[catnhatnh]

9. Why would you have a guy with a Masters in economics...

in charge of health systems performance studies??? I mean shouldn't a guy studying that have an MD somewhere in his background???

[Hekate]

11. The US rations health care based on what you can afford--when your money's gone...

... you can die in an alley for all the insurance companies care.

Hekate

[Enthusiast]

12. Wake the fuck up!

This piece is pure propaganda. It was written on behalf of an insurance and pharmaceutical industry that want to maintain their cash cow. There are millions of American healthcare horror stories that never see print, I even have one of my own and know of many others.

This stated goal by our president, of changing healthcare, is why you are witnessing this Republican anti-Obama ranting and frothing at the mouth. Why have these Reich Wing types stepped up their attacks? Because they are protecting the narrow interests of a few at the expense of millions. Heathcare is only one issue. There is The Military Industrial Complex and the big polluters.

[ProgressiveProfessor]

16. The problem is that such cases do exist and when the fight comes they will be all over the airwaves

[depakid]

13. The Fraser Institute = CATO Canada

Stupid libertarians.

(a tautology, I know).

[Daveparts]

14. Only two kinds of people like America's health system

The healthy and the insurance companies

[Stellabella]

15. And the wealthy.

I have a wealthy relative who pays a fixed fee (very large, too) to a doctor every year for 'premium' care. The doctor doesn't even accept insurance cards or Medicare. He's doing very well, thank you.

[question everything]

22. That doctor saves a lot on over head. Extra stuff to handle the paperwork

for the various insurance companies and to haggle with them about a "miscoded" charge.

[Stellabella]

24. Yep, I know.

I can't imagine being in that kind of situation, myself - must be nice.

[unapatriciated]

18. word

SiCO

http://www.michaelmoore.com/sicko/checkup/

[LeftishBrit]

19. Something doesn't sound quite right here

The UK has an NHS, *and* has had it badly weakened by cost-cutting governments. But no one would be told, certainly at 57, that they were too old for a hip replacement. They might have to wait a few months for the surgery, as it's 'non-emergency', but they would be able to have it! After all, most people who *need* hip replacements are that age or older, so there's something here that makes no sense.

And there is *no way* that someone would have to wait months for further investigation if a scan had already revealed a serious condition like a brain tumour.

I find it hard to believe that it's so much worse in Canada.

[question everything]

21. I think that many who support universal health care do not want to follow Canada

or the UK. I think that Germany and France have a much better system.

[SharonAnn]

23. There's a LOT that doesn't sound right here. And, consider the source, the WSJ.

[skepticscott]

26. As usual, they trot out the scare tactics

regarding wait times for certain procedures, while forgetting to mention that for the tens of millions of Americans who have no health insurance, the wait time is not 3 months or 6 months, but forever. Or until they die. Funny how all of those "forevers" are never figured in when they compare average wait times for surgeries between the US and countries that have national health insurance.

[fasttense]

27. Oh my God, they had to what... wait???

In the good old US of A you get to wait too. You get to wait until you've saved enough money to cover the cost. How long do you think all those charity cases who collect money at the checkout counter have to wait for operations they can't afford?

How about those people who have to wait until they can get a job with health insurance. Or those who think they have good health coverage, who are waiting until the insurance company finishes messing up the paperwork or finds it after losing it 3 times.

Remember the guy who died in the emergency room while waiting? How about waiting in the overcrowded emergency room. They are overcrowded because people who can't afford health-care insurance use them as their primary care providers.

If waiting is the ONLY thing I have to worry about in regards to my health care than I've got absolutely nothing to worry about.

[bertman]

28. I am absolutely and unequivocally for universal, single-payer health care; however,

I don't think it is beyond the realm of practical reality to wonder how we are going to treat all who need treatment IF and hopefully WHEN the day comes that everyone has free coverage.

Living in an area served by numerous medical centers and one very good state hospital complex, I have personally witnessed the sheer numbers of folks who come to the state hospital for care. The clinics are PACKED with folks who cannot afford to go to a privately owned medical facility. The service is excellent but there are sometimes pretty long waits for specialized surgical procedures. Imagine if everyone was able to seek medical care without having to worry about losing their home to afford it.

Good questions are being raised regarding who gets the priority for health care. Does a 30-year cigarette smoker get first dibs on a lung transplant over a non-smoker? Does an obese couch potato who lives on fast food get heart surgery before the individual who has lived healthfully and needs the surgery?

I have a friend whose father is a crack head who has numerous serious medical problems but will not stop cracking and drinking so he ends up in the emergency room at the state hospital and takes up space that others might need--over and over again. And, yes, he has been offered rehab options but repeatedly refuses them because he loves his crack and booze and loose women and knows the state hospital will take him in when he is about to kill himself again.

How do countries such as Germany and France deal with these dilemmas? Anybody know?

[LeftishBrit]

30. Decisions are (and should be) based on likelihood of benefit, not 'deservingness'

Thus, a person's habits should not be taken into account from the point of view of whether they're to blame for their illness; but they may be, if they affect the likelihood of success of a treatment. Thus, an alcoholic may be less likely to get a liver transplant, because the new liver is less likely to function if the person continues to drink. A *recovered* alcoholic, however, should have an equal chance of a liver transplant to someone who needs it because of (say) complications from a congenital disorder. There are other issues that can validly be considered: e.g. while it's ridiculous to treat a 57-year-old as 'too old' for a hip replacement, one might advise against giving a 90-year-old a kidney transplant, as they are usually more likely to die sooner from the surgery and associated drug treatments than the illness.

As regards the crackhead: I don't think there's a way of dealing with the situation, that would not potentially prevent others from getting the treatments they need. Universal needs to mean universal. However, in countries where everyone has a GP, people are less likely to end up in the emergency room for illnesses that are chronic and not an emergency.

In the UK, there is currently (post-Thatcher) a tendency to consider costs too much in deciding which drugs to use for patients. People in Scotland - which is a bit less Thatcherized than England - can sometimes get useful but expensive drugs when their English counterparts would not.

[bertman]

31. Thanks for the perspective, LeftishBrit. I was having visions of some 45 year-old

ne'er do well with a history of drug and alcohol abuse being in need of a triple bypass heart operation, while, at the same time and hospital, a 21 year-old in excellent health except for a just-discovered, deadly heart condition needs the same surgery. Who gets priority?

I realize this is hypothetical and more of an ethical question than a medical question, but if the 21 year-old were my child I know where my sentiments would lie.

[ShortnFiery]

29. Yes, the bilge-water GOP and RushBo are also "on a tear" to frighten the elderly.

How low class and sadly PATHETIC of them. :puke: