Full Version: Legislating Medical Care
In President Bush’s last State of the Union Address, he made a statement that I heartily support, “we will ensure that decisions about your medical care are made in the privacy of your doctor's office, not in the halls of Congress.”
Many here have read the thread already where our 6 week old baby was seized by sheriff’s deputies to perform a blood test for certain metabolic diseases that were a .016% chance to the general population. This test was legislated as mandatory with no exceptions by our state unicameral in 1983. However, until 2003, no one ever attempted to enforce the law and hundreds of parents, (me included with 5 separate children), simply ignored the law. Our opposition admitted in legislative testimony recently that no babies in our state have gone undiagnosed since 1973. That means 10 years before the screening was made mandatory and the 20 years in which it was unenforced, there were no negative consequences. In other words, voluntary screening was already discovering all the babies with disease.
There is another infant screening now that parents are told is mandatory and it is done automatically in hospitals.
All hospitals in Nebraska, including small rural ones, have been required to purchase expensive hearing screening equipment in order to test the hearing of newborn infants. This is commonly accomplished by hooking the newborn up to electrodes and measuring brain wave responses to sound. The justification for this procedure is that 0.3% of infants have some significant hearing loss and it is better to discover it earlier rather than later. This test has 30% refer (false positive) rate. Also, treatment is not generally started until the infant is 6 months old. There is no scientific research demonstrating improved outcomes since the implementation of this screening. See http://www.aafp.org/afp/20070501/1349.html It has the lowest possible evidence rating.
I have yet to have a baby that I could not determine if they could hear within a normal range by 6 weeks just by simple observation. By 6 months, I honestly do not see how any parent could miss a significant hearing loss. However, given the state of today’s society, I am sure there are some parents who are less observant. Does that give the state the right or the obligation to step in for all parents?
Topics for debate:
Should any medical procedures be mandated by Congress? What about state legislatures? Why or why not?
Obviously, I do not think Congress has any business getting involved in health care. Period. That is from my strict view of the U.S. Constitution. Also, in reading my state constitution, I do not see where there is room for legislating medical procedures with the possible exception of an imminent public health hazard.
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
Congress-never. It is unconstitutional. State legislatures-I doubt it. I could perhaps see it justified if the preponderance of evidence indicates a 50% or higher likelihood of death or serious injury or something highly communicable that presents a significant danger to the general public. I have never heard of anything like that. I would be concerned about who is providing the evidence and whether or not it is unbiased.
Many here have read the thread already where our 6 week old baby was seized by sheriff’s deputies to perform a blood test for certain metabolic diseases that were a .016% chance to the general population. This test was legislated as mandatory with no exceptions by our state unicameral in 1983. However, until 2003, no one ever attempted to enforce the law and hundreds of parents, (me included with 5 separate children), simply ignored the law. Our opposition admitted in legislative testimony recently that no babies in our state have gone undiagnosed since 1973. That means 10 years before the screening was made mandatory and the 20 years in which it was unenforced, there were no negative consequences. In other words, voluntary screening was already discovering all the babies with disease.
There is another infant screening now that parents are told is mandatory and it is done automatically in hospitals.
All hospitals in Nebraska, including small rural ones, have been required to purchase expensive hearing screening equipment in order to test the hearing of newborn infants. This is commonly accomplished by hooking the newborn up to electrodes and measuring brain wave responses to sound. The justification for this procedure is that 0.3% of infants have some significant hearing loss and it is better to discover it earlier rather than later. This test has 30% refer (false positive) rate. Also, treatment is not generally started until the infant is 6 months old. There is no scientific research demonstrating improved outcomes since the implementation of this screening. See http://www.aafp.org/afp/20070501/1349.html It has the lowest possible evidence rating.
I have yet to have a baby that I could not determine if they could hear within a normal range by 6 weeks just by simple observation. By 6 months, I honestly do not see how any parent could miss a significant hearing loss. However, given the state of today’s society, I am sure there are some parents who are less observant. Does that give the state the right or the obligation to step in for all parents?
Topics for debate:
Should any medical procedures be mandated by Congress? What about state legislatures? Why or why not?
Obviously, I do not think Congress has any business getting involved in health care. Period. That is from my strict view of the U.S. Constitution. Also, in reading my state constitution, I do not see where there is room for legislating medical procedures with the possible exception of an imminent public health hazard.
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
Congress-never. It is unconstitutional. State legislatures-I doubt it. I could perhaps see it justified if the preponderance of evidence indicates a 50% or higher likelihood of death or serious injury or something highly communicable that presents a significant danger to the general public. I have never heard of anything like that. I would be concerned about who is providing the evidence and whether or not it is unbiased.
QUOTE(NebraskaMom @ Feb 21 2008, 08:50 PM) 
[b]Should any medical procedures be mandated by Congress? What about state legislatures? Why or why procedures with the possible exception of an imminent public health hazard.
Keep your hands off my body and on that of your mistress, Mr. Congressman. The government has no stake in my body, so let me decide how best to ruin it.
It is nothing short of a violation for any government body to regulate doctor/patient relations. Most people have enough sense to consult a medical professional, and that is where decisions such as this should always be made. Other than keeping tax payers alive for as long as possible, the government ought not to have a vested interest in the level of medical care a person chooses to receive.
QUOTE(VDemosthenes @ Feb 22 2008, 08:15 AM)
QUOTE(NebraskaMom @ Feb 21 2008, 08:50 PM)
[b]Should any medical procedures be mandated by Congress? What about state legislatures? Why or why procedures with the possible exception of an imminent public health hazard.
Keep your hands off my body and on that of your mistress, Mr. Congressman. The government has no stake in my body, so let me decide how best to ruin it.
It is nothing short of a violation for any government body to regulate doctor/patient relations. Most people have enough sense to consult a medical professional, and that is where decisions such as this should always be made. Other than keeping tax payers alive for as long as possible, the government ought not to have a vested interest in the level of medical care a person chooses to receive.
I am with you, but we also need to keep the health of the general population in mind. For 99% of any medical issues, insurance companies and politicians have no place in the decision making process between a doctor and patient, or even if the patient should decide to consult a doctor. It is that 1%, the pandemics and epidemics that we require some control by our government. Fortunately for us, we don't have very many of those incidents, but to maintain order, I think we would need the assistance of the government.
Should any medical procedures be mandated by Congress? What about state legislatures? Why or why not?
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
Very few medical procedures should need compulsion, but some do. As scubatim has mentioned, there are some diseases and disease states that have a public health or public saftey dimension to them; nobody wants to see another Typhoid Mary running around getting other people killed and refusing simple treatment themselves that would solve the problem.
That extends to the imposition of quarantine, which can be a kind of treatment in and of itself (especially for incurable but highly infectious diseases such as the Ebola virus, though let's all hope that never becomes a really large scale problem).
Also, let's not forget that in some mental health conditions, patients need to be sectioned for their own safety or the safety of others, and drug and other treatments in such circumstances need to be imposed against the will of the patient, at least until the crisis is passed.
Such treatments are perfectly constitutional, too, under the general welfare clause (because the action is driven primarily by concern for the majority of citizens rather than the individual).
In the specific instance of screening for deafness you mention, I have to agree with you that screening of newborns is not only an imposition but can't be medically all that useful. Though I daresay the problem is, at root, that the structure of medicine in the USA is such that they can't be sure that they'll ever see the child again after birth; treatment is not free at the point of use, so uninsured parents may not be able to afford to bring their children in very often. If the next time after birth that a child is seen by the state is when they start school, it may already have hearing problems and knock-on developmental delays (in speaking, socialising, etc.) that might need extra state help. My point is that I can sort of understand the logic for testing, even though I don't agree with it. And that my reasons for diagreeig are practical, not constitutional. The sooner you have a universal (if basic) healthcare system funded through taxation the better; Medicare is not it - and you'd be better off copying the French or German models than the British one.
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
Very few medical procedures should need compulsion, but some do. As scubatim has mentioned, there are some diseases and disease states that have a public health or public saftey dimension to them; nobody wants to see another Typhoid Mary running around getting other people killed and refusing simple treatment themselves that would solve the problem.
That extends to the imposition of quarantine, which can be a kind of treatment in and of itself (especially for incurable but highly infectious diseases such as the Ebola virus, though let's all hope that never becomes a really large scale problem).
Also, let's not forget that in some mental health conditions, patients need to be sectioned for their own safety or the safety of others, and drug and other treatments in such circumstances need to be imposed against the will of the patient, at least until the crisis is passed.
Such treatments are perfectly constitutional, too, under the general welfare clause (because the action is driven primarily by concern for the majority of citizens rather than the individual).
In the specific instance of screening for deafness you mention, I have to agree with you that screening of newborns is not only an imposition but can't be medically all that useful. Though I daresay the problem is, at root, that the structure of medicine in the USA is such that they can't be sure that they'll ever see the child again after birth; treatment is not free at the point of use, so uninsured parents may not be able to afford to bring their children in very often. If the next time after birth that a child is seen by the state is when they start school, it may already have hearing problems and knock-on developmental delays (in speaking, socialising, etc.) that might need extra state help. My point is that I can sort of understand the logic for testing, even though I don't agree with it. And that my reasons for diagreeig are practical, not constitutional. The sooner you have a universal (if basic) healthcare system funded through taxation the better; Medicare is not it - and you'd be better off copying the French or German models than the British one.
QUOTE(scubatim @ Feb 22 2008, 10:30 AM)
I am with you, but we also need to keep the health of the general population in mind. For 99% of any medical issues, insurance companies and politicians have no place in the decision making process between a doctor and patient, or even if the patient should decide to consult a doctor. It is that 1%, the pandemics and epidemics that we require some control by our government. Fortunately for us, we don't have very many of those incidents, but to maintain order, I think we would need the assistance of the government.
My huge gripe is that government trying to mandate insurance is limiting of free enterprise since insurance is an enterprise and a business designed to make money. Sure, it shells it out for people who put into the system, but insurance is private and therefore is an American business. It's been a founding tenant of this nation to not muck up private ownership. When the government starts dicating to corporations, we're dealing with facism.
QUOTE(VDemosthenes @ Feb 23 2008, 12:10 PM)
QUOTE(scubatim @ Feb 22 2008, 10:30 AM)
I am with you, but we also need to keep the health of the general population in mind. For 99% of any medical issues, insurance companies and politicians have no place in the decision making process between a doctor and patient, or even if the patient should decide to consult a doctor. It is that 1%, the pandemics and epidemics that we require some control by our government. Fortunately for us, we don't have very many of those incidents, but to maintain order, I think we would need the assistance of the government.
My huge gripe is that government trying to mandate insurance is limiting of free enterprise since insurance is an enterprise and a business designed to make money. Sure, it shells it out for people who put into the system, but insurance is private and therefore is an American business. It's been a founding tenant of this nation to not muck up private ownership. When the government starts dicating to corporations, we're dealing with facism.
Another key on that front is to keep in mind how many people are entering what I call the fourth quarter of life. The baby-boomers are going to be/are retiring. In droves. This in and of itself is secondary, however, health conditions typically decline at this stage in life. Cancer, heart attacks, Alzheimer's, accidents etc. are more common among the elderly. Fortunately, our medicine is better today than it was 50 years ago. People are dying less, and living longer even after what can be terminal. It is erroneous at best to say our government is going to be able to support the increases in the medical costs for the elderly through either Medicare or some form of Universal Health care. If the government thought it was going to be able to support the upcoming influx of people in the system, they wouldn't make it possible to deduct some or all of the costs of supplements and long term care insurance.
Should any medical procedures be mandated by Congress? What about state legislatures? Why or why not?
There have been extraordinary successes in legislated treatment as well, such as the eradication of polio. If you recall, polio exists very rarely in the wild anymore, and with widespread vaccination was eliminated from the United States by 1979 and the Western hemisphere by 1991. Many other vaccines have also greatly reduced the number of death from disease over the years, and those treatments are legislated in part by state requirements. Many others are left as optional, like flu vaccines.
Also, although legislated community by community, fluoride also has caused a dramatic drop in dental caries. Optional topical use (as through toothpastes), has caused even greater reductions of such disease.
Given the dramatic rises in the cost of health care over the years, disproportionate to the rise in the cost of other things due to inflation, medical care is slowly becoming unaffordable to more of the population. A recent Harvard study identified unreimbursed medical expenses to be related to half of all bankrupcies in the U.S. Prevention may ultimately be the only way to keep those costs from causing even greater public outrage than you are expressing.
Although statisitically white children have a very low rate of frank metabolic disease, there certainly is a high risk in other segments of the population. I believe 1 in 5 Hispanics has a genetic profile that predisposes them to metabolic disease which is why they often are diagnosed with type 2 diabetes. Blacks and Asians also have higher rates. Some native American Indian populations have type II diabetes rates exceeding 55% and likely have genetic predispositions exceeding 80% of the population. Given that the highest cost medical treatment comes directly from chronic disease complications from metabolic problems like that, I don't find it surprising that some states are screening for it at an early age.
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
States typically have been the ones to legislate medical requirements for themselves. But any community can do so. Fluoride is one such issue in some states, where the state often stays out of the fray, simply allowing individual communities to legislate their own rules on a case by case basis. State medical boards also typically determine what is considered to be the standard of care also, as well as issues of ethics.
If Congress establishes some sort of national health care, then that would presumably be the legislative body regulating it. Or perhaps it may just be a financial backer for a slew of mandatory state run health care systems. I see no specific problem with that per se, since they would presumably simply be deciding how much would be reimbursed for different types of procedures, not mandating specific treatment. And if they simply fund the states, then the states would be doing that determination.
I think it is misleading of some people to imply Congress would actually determine medical treatment, since by that logic the same problem already exists with private insurance, since insurance companies also determine treatment coverages. I personally have less faith in private insurance because the profit motive rewards insurance companies when they purposely obscure the stipulations of those coverages, making it more likely people will be denied treatment. When it comes to the understanding of details of treatment coverage, the issues are mostly too complex for most consumers, and the temptation to pull the wool over the eyes of the consumer is too great.
In fact, I have no doubt the existing problems of private health insurance are one of the direct causes of the rise of medical tourism in this country. The increasing numbers of uninsured or underinsured simply have no where else to turn other than overseas. Given that many of the destination countries are countries that also have universal health care for their citizens, such as France, it would suggest that the presence of universal care also tends to keep local private medical expenses low.
Getting back to the actual question of the topic, though, I don't forsee any great role for some sort of mandated treatment directly from Congress, but there are plenty of indirect ways in which Congress could encourage states to take up legislative leadership in medical intervention in major problems which may cause serious economic harm to a national health program. Given that most deaths in this country are linked to complications from chronic diseases, and given that early detection and treatment saves enormous amounts of time and money in treatment, not to mention disproportionately increases survival rates, - screening for such predispositions seems to be an obvious first step in any health effort concerned with both increasing survival rates and reducing systemic costs. Unlike screening done by private insurance, however, with public screening, an at-risk person would be directed toward treatment rather than away from coverage.
There have been extraordinary successes in legislated treatment as well, such as the eradication of polio. If you recall, polio exists very rarely in the wild anymore, and with widespread vaccination was eliminated from the United States by 1979 and the Western hemisphere by 1991. Many other vaccines have also greatly reduced the number of death from disease over the years, and those treatments are legislated in part by state requirements. Many others are left as optional, like flu vaccines.
Also, although legislated community by community, fluoride also has caused a dramatic drop in dental caries. Optional topical use (as through toothpastes), has caused even greater reductions of such disease.
Given the dramatic rises in the cost of health care over the years, disproportionate to the rise in the cost of other things due to inflation, medical care is slowly becoming unaffordable to more of the population. A recent Harvard study identified unreimbursed medical expenses to be related to half of all bankrupcies in the U.S. Prevention may ultimately be the only way to keep those costs from causing even greater public outrage than you are expressing.
Although statisitically white children have a very low rate of frank metabolic disease, there certainly is a high risk in other segments of the population. I believe 1 in 5 Hispanics has a genetic profile that predisposes them to metabolic disease which is why they often are diagnosed with type 2 diabetes. Blacks and Asians also have higher rates. Some native American Indian populations have type II diabetes rates exceeding 55% and likely have genetic predispositions exceeding 80% of the population. Given that the highest cost medical treatment comes directly from chronic disease complications from metabolic problems like that, I don't find it surprising that some states are screening for it at an early age.
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
States typically have been the ones to legislate medical requirements for themselves. But any community can do so. Fluoride is one such issue in some states, where the state often stays out of the fray, simply allowing individual communities to legislate their own rules on a case by case basis. State medical boards also typically determine what is considered to be the standard of care also, as well as issues of ethics.
If Congress establishes some sort of national health care, then that would presumably be the legislative body regulating it. Or perhaps it may just be a financial backer for a slew of mandatory state run health care systems. I see no specific problem with that per se, since they would presumably simply be deciding how much would be reimbursed for different types of procedures, not mandating specific treatment. And if they simply fund the states, then the states would be doing that determination.
I think it is misleading of some people to imply Congress would actually determine medical treatment, since by that logic the same problem already exists with private insurance, since insurance companies also determine treatment coverages. I personally have less faith in private insurance because the profit motive rewards insurance companies when they purposely obscure the stipulations of those coverages, making it more likely people will be denied treatment. When it comes to the understanding of details of treatment coverage, the issues are mostly too complex for most consumers, and the temptation to pull the wool over the eyes of the consumer is too great.
In fact, I have no doubt the existing problems of private health insurance are one of the direct causes of the rise of medical tourism in this country. The increasing numbers of uninsured or underinsured simply have no where else to turn other than overseas. Given that many of the destination countries are countries that also have universal health care for their citizens, such as France, it would suggest that the presence of universal care also tends to keep local private medical expenses low.
Getting back to the actual question of the topic, though, I don't forsee any great role for some sort of mandated treatment directly from Congress, but there are plenty of indirect ways in which Congress could encourage states to take up legislative leadership in medical intervention in major problems which may cause serious economic harm to a national health program. Given that most deaths in this country are linked to complications from chronic diseases, and given that early detection and treatment saves enormous amounts of time and money in treatment, not to mention disproportionately increases survival rates, - screening for such predispositions seems to be an obvious first step in any health effort concerned with both increasing survival rates and reducing systemic costs. Unlike screening done by private insurance, however, with public screening, an at-risk person would be directed toward treatment rather than away from coverage.
QUOTE(scubatim @ Feb 23 2008, 02:10 PM)
Another key on that front is to keep in mind how many people are entering what I call the fourth quarter of life. The baby-boomers are going to be/are retiring. In droves. This in and of itself is secondary, however, health conditions typically decline at this stage in life. Cancer, heart attacks, Alzheimer's, accidents etc. are more common among the elderly. Fortunately, our medicine is better today than it was 50 years ago. People are dying less, and living longer even after what can be terminal. It is erroneous at best to say our government is going to be able to support the increases in the medical costs for the elderly through either Medicare or some form of Universal Health care. If the government thought it was going to be able to support the upcoming influx of people in the system, they wouldn't make it possible to deduct some or all of the costs of supplements and long term care insurance.
Call me the Angel of Pessimism, but longer life = longer payments have to be made for them.
Granted, medicine is better, but it costs more. Life would be so much easier if people could afford health insurance, but some people want to muck up the system and let the government take care of everyone. It's wrong and it's a pursuit of the lazy [can the lazy pursue something?
] I'm not decrying those truly unable to afford health insurance, but the nation could step up programs for those people and not have to overhaul it for the 250+ million others of us who can afford it.
QUOTE
My huge gripe is that government trying to mandate insurance is limiting of free enterprise since insurance is an enterprise and a business designed to make money. Sure, it shells it out for people who put into the system, but insurance is private and therefore is an American business. It's been a founding tenant of this nation to not muck up private ownership. When the government starts dictating to corporations, we're dealing with fascism.
Far from fascism.
Another way to look at it is simply the buying power of the public.
Why is it a good thing when Wal Mart can reduce costs by buying in bulk as well as demand that its suppliers meets wal mart's needs, but somehow bad when consumers get together and try to buy in bulk for the best price?
Wal Mart all the time forces its suppliers to not just supply their product at Wal Mart's price but quite simply in the format Wal Mart decides is best for its own business needs. They demand certain quantities packaged a certain way and delivered according to certain schedules and guidelines.
Most of health care needs are static, flu, colds etc. We know for the most part what will be in demand and we can estimate how much for much of it will be needed. I see no problem with saying to the health care industry this is we what we need and what we are willing to pay. The businesses who can build the necessary model will succeed and those unable to will fail and die off. Otherwise known as the Free Market.
QUOTE
Granted, medicine is better, but it costs more. Life would be so much easier if people could afford health insurance, but some people want to muck up the system and let the government take care of everyone. It's wrong and it's a pursuit of the lazy [can the lazy pursue something? whistling.gif] I'm not decrying those truly unable to afford health insurance, but the nation could step up programs for those people and not have to overhaul it for the 250+ million others of us who can afford it.
Far too many of my fellow free market evangelists seem very eager to whore everyone out for the needs and wants of the market players.
Smart sensible businesses get the best value for their money--otherwise they are out of business. To somehow say that the buying public is wrong to demand the best value for their money is silly.
The free market will allow the companies who are able to meet the need to thrive and those who cannot SHOULD be forced out of business as there is no place in the free market for businesses that need protection from competition to survive.
Simply we have 300 million people willing to pay this amount for this service. what can you do for me Bub?
If you cannot or are not willing I am sure your competition is willing to make me an attractive offer.
Time to stop the protecting weak businesses and force them back into competition in the only place where Darwinism has any place being a deciding factor in civilization, the Free Market.
QUOTE(metropolitical @ Feb 23 2008, 06:45 PM)
Should any medical procedures be mandated by Congress? What about state legislatures? Why or why not?
Although statisitically white children have a very low rate of frank metabolic disease, there certainly is a high risk in other segments of the population. I believe 1 in 5 Hispanics has a genetic profile that predisposes them to metabolic disease which is why they often are diagnosed with type 2 diabetes. Blacks and Asians also have higher rates. Some native American Indian populations have type II diabetes rates exceeding 55% and likely have genetic predispositions exceeding 80% of the population. Given that the highest cost medical treatment comes directly from chronic disease complications from metabolic problems like that, I don't find it surprising that some states are screening for it at an early age.
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
States typically have been the ones to legislate medical requirements for themselves. But any community can do so. Fluoride is one such issue in some states, where the state often stays out of the fray, simply allowing individual communities to legislate their own rules on a case by case basis. State medical boards also typically determine what is considered to be the standard of care also, as well as issues of ethics.
If Congress establishes some sort of national health care, then that would presumably be the legislative body regulating it. Or perhaps it may just be a financial backer for a slew of mandatory state run health care systems. I see no specific problem with that per se, since they would presumably simply be deciding how much would be reimbursed for different types of procedures, not mandating specific treatment. And if they simply fund the states, then the states would be doing that determination.
I think it is misleading of some people to imply Congress would actually determine medical treatment, since by that logic the same problem already exists with private insurance, since insurance companies also determine treatment coverages. I personally have less faith in private insurance because the profit motive rewards insurance companies when they purposely obscure the stipulations of those coverages, making it more likely people will be denied treatment. When it comes to the understanding of details of treatment coverage, the issues are mostly too complex for most consumers, and the temptation to pull the wool over the eyes of the consumer is too great.
In fact, I have no doubt the existing problems of private health insurance are one of the direct causes of the rise of medical tourism in this country. The increasing numbers of uninsured or underinsured simply have no where else to turn other than overseas. Given that many of the destination countries are countries that also have universal health care for their citizens, such as France, it would suggest that the presence of universal care also tends to keep local private medical expenses low.
Getting back to the actual question of the topic, though, I don't forsee any great role for some sort of mandated treatment directly from Congress, but there are plenty of indirect ways in which Congress could encourage states to take up legislative leadership in medical intervention in major problems which may cause serious economic harm to a national health program. Given that most deaths in this country are linked to complications from chronic diseases, and given that early detection and treatment saves enormous amounts of time and money in treatment, not to mention disproportionately increases survival rates, - screening for such predispositions seems to be an obvious first step in any health effort concerned with both increasing survival rates and reducing systemic costs. Unlike screening done by private insurance, however, with public screening, an at-risk person would be directed toward treatment rather than away from coverage.
Although statisitically white children have a very low rate of frank metabolic disease, there certainly is a high risk in other segments of the population. I believe 1 in 5 Hispanics has a genetic profile that predisposes them to metabolic disease which is why they often are diagnosed with type 2 diabetes. Blacks and Asians also have higher rates. Some native American Indian populations have type II diabetes rates exceeding 55% and likely have genetic predispositions exceeding 80% of the population. Given that the highest cost medical treatment comes directly from chronic disease complications from metabolic problems like that, I don't find it surprising that some states are screening for it at an early age.
If you think that either the state legislatures and/or Congress should have a role in mandating medical procedures, explain when you would consider it appropriate.
States typically have been the ones to legislate medical requirements for themselves. But any community can do so. Fluoride is one such issue in some states, where the state often stays out of the fray, simply allowing individual communities to legislate their own rules on a case by case basis. State medical boards also typically determine what is considered to be the standard of care also, as well as issues of ethics.
If Congress establishes some sort of national health care, then that would presumably be the legislative body regulating it. Or perhaps it may just be a financial backer for a slew of mandatory state run health care systems. I see no specific problem with that per se, since they would presumably simply be deciding how much would be reimbursed for different types of procedures, not mandating specific treatment. And if they simply fund the states, then the states would be doing that determination.
I think it is misleading of some people to imply Congress would actually determine medical treatment, since by that logic the same problem already exists with private insurance, since insurance companies also determine treatment coverages. I personally have less faith in private insurance because the profit motive rewards insurance companies when they purposely obscure the stipulations of those coverages, making it more likely people will be denied treatment. When it comes to the understanding of details of treatment coverage, the issues are mostly too complex for most consumers, and the temptation to pull the wool over the eyes of the consumer is too great.
In fact, I have no doubt the existing problems of private health insurance are one of the direct causes of the rise of medical tourism in this country. The increasing numbers of uninsured or underinsured simply have no where else to turn other than overseas. Given that many of the destination countries are countries that also have universal health care for their citizens, such as France, it would suggest that the presence of universal care also tends to keep local private medical expenses low.
Getting back to the actual question of the topic, though, I don't forsee any great role for some sort of mandated treatment directly from Congress, but there are plenty of indirect ways in which Congress could encourage states to take up legislative leadership in medical intervention in major problems which may cause serious economic harm to a national health program. Given that most deaths in this country are linked to complications from chronic diseases, and given that early detection and treatment saves enormous amounts of time and money in treatment, not to mention disproportionately increases survival rates, - screening for such predispositions seems to be an obvious first step in any health effort concerned with both increasing survival rates and reducing systemic costs. Unlike screening done by private insurance, however, with public screening, an at-risk person would be directed toward treatment rather than away from coverage.
No state screens newborns for diabetes that I have heard of. The mandatory newborn screenings are for unpreventable extremely rare non-contagious diseases. The newborn hearing screening is simply worthless and an intrusion upon the private lives of citizens. I am shocked at how easily people are willing to give up freedom. I do not want to be told I MUST go the the doctor or hospital by any bureaucrat for any screening. The very idea infuriates me. What happened to "Give my liberty or give me death." Are you all willing to go to the screening appointments because of sweeping government mandates? I am not.
QUOTE(NebraskaMom @ Mar 8 2008, 09:05 PM)
No state screens newborns for diabetes that I have heard of. The mandatory newborn screenings are for unpreventable extremely rare non-contagious diseases. The newborn hearing screening is simply worthless and an intrusion upon the private lives of citizens. I am shocked at how easily people are willing to give up freedom. I do not want to be told I MUST go the the doctor or hospital by any bureaucrat for any screening. The very idea infuriates me. What happened to "Give my liberty or give me death." Are you all willing to go to the screening appointments because of sweeping government mandates? I am not.
I's really hard to apply Patrick Henry's "give me libert or give me death." There was a crude vaccination for small pox, but it wasn't until much later that the medical science discovered that diseases like smallpox and yellow fever were caused by a virus.
If they founders had known what we know now, I think they would have favored measures, even mandatory, to protect the nation's' health. In addition to the Constitution, the founders gave us public libraries and publuc universities. Why would thet oppose public health?
They were hardly libertarian junkies.
We are not talking about vaccines for contagious diseases. We are not talking about treatment of diseases. We are talking about the state mandating that all people of whatever the mandated age or class-no matter how healthy they believe themselves to be-being forced to make an appt. with a doctor or a lab to undergo a screening just because the state says so. This is being done right now in the name of cost-effective health care. Where is the state's compelling interest in this? Why shouldn't people who sincerely believe that they do not have a disease be allowed to opt out?
QUOTE(NebraskaMom @ Mar 9 2008, 05:23 PM)
We are not talking about vaccines for contagious diseases. We are not talking about treatment of diseases. We are talking about the state mandating that all people of whatever the mandated age or class-no matter how healthy they believe themselves to be-being forced to make an appt. with a doctor or a lab to undergo a screening just because the state says so. This is being done right now in the name of cost-effective health care. Where is the state's compelling interest in this? Why shouldn't people who sincerely believe that they do not have a disease be allowed to opt out?
No, and we are not talking about what Patrick Henry's famous saying was about.
The answer is simple!
Often, if diseases are caught early enough they are easier and more affordable to treat and could provide the person who is ill with better quality of life and a longer life. It seems like a no-brainer to me.
QUOTE(BoF @ Mar 9 2008, 06:25 PM)
No, and we are not talking about what Patrick Henry's famous saying was about.
The answer is simple!
Often, if diseases are caught early enough they are easier and more affordable to treat and could provide the person who is ill with better quality of life and a longer life. It seems like a no-brainer to me.
The answer is simple!
Often, if diseases are caught early enough they are easier and more affordable to treat and could provide the person who is ill with better quality of life and a longer life. It seems like a no-brainer to me.
Really? My opening specifically used the newborn hearing screening as an example. Hearing loss can be a disability but is not exactly the same as a disease. The physician's reference site admits that there is no research that the screening improves outcomes.
This screening has recently been made mandatory in a neighboring state. I just read the complaint of a mother who objects to the screening for purely utilitarian reasons. Her 7th child was born at home a few months ago. Over a month after the birth she received a notice about the hearing screening. Since it had not been the law with her previous children and she had not heard about it she did not immediately respond. By the time the screening department personally contacted her and explained to her that this was now law and she must comply, her baby was over 3 months. By this age the infant would turn her head in response to a whisper and could quite obviously hear. The mother is outraged to be told by the state that she must do this screening. In order to comply she must take her baby (and her other 6 children since her husband works long hours) an hour and a half drive away to the nearest hospital that performs the screening. This means a 3 hour round trip in a gas guzzling full size van. Also, given the likely wait in the hospital for the lab to conduct the rather long screening, she will be forced to resort to fast food given too many hours away from home. This mother naturally is upset. The state is asking her to do all of this and pay for the screening at her own expense, yet it is the state that wants the information.
Even if something appears cost-effective on a larger scale (that has not even been established with the hearing screening), there are times where it is obviously not cost-effective to the individual.
QUOTE(NebraskaMom @ Mar 10 2008, 06:26 AM)
Even if something appears cost-effective on a larger scale (that has not even been established with the hearing screening), there are times where it is obviously not cost-effective to the individual.
Hearing is vital. It is one of the primary learning modalities. Cost effective or not, I think it would be desirable to to know this information, before the child entered school. The child's health outstrips the parent's rights. The right of the parent here is to make their vie known. You are certainly doing that, but it appears your efforts on this and other matters are as Bob Dylan put it, "blowing in in the wind."
QUOTE(NebraskaMom @ Mar 10 2008, 06:26 AM)
This means a 3 hour round trip in a gas guzzling full size van. Also, given the likely wait in the hospital for the lab to conduct the rather long screening, she will be forced to resort to fast food given too many hours away from home. This mother naturally is upset. The state is asking her to do all of this and pay for the screening at her own expense, yet it is the state that wants the information.
We are all suffering the ills of high gasoline prices. Maybe you should get a vehicle that consumes less gas. If a three hour round trip and fast food are the biggest inconvenience you have in your life, you will be doing well.
Freedom will be tromped upon if you had your way, BoF. If it is good with you, it should be mandated to everyone. It should not be a call of government to make personal, private, decisions. Medical care is a paramount private decision process. Never should an individual's private health problems be a concern of government.
It is fine to educate people about risk, costs, and benefits. Individuals can make their own decisions based upon such. Governments, despite what some people preposterously think, do not look out for individuals. They look out for groups, especially those which gets them elected. Government's intrusion is a lose of freedom which is people being seen as individuals. It is not OK for people who think they know best for everyone to intrude into private decisions.
There are times where government intrusion into health care, when you treat humans as a herd, are reasonable. Such would be mass vaccinations to stop disease transmissions. There has to be a high risk that individuals can be infected through no fault of their own to do such. Here you are protecting individuals against others.
Never should government intrude into private health care decision of an individual to protect them against themselves. That is blatant elimination of freedom, one which needs to be protected via an amendment to the constitution as another limitation of government. A right to privacy should be respected as a basic liberty and that has to include one's body.
--------------------------
The cost of medical services is way out of whack. Government intrusion with laws affecting the market place are much to blame. As more federal laws dealing with health have increased, so have market prices risen. It is predictable that as supply and demand cost are separated, prices will rise. In other words, if you do not have to pay for something (it is free or low price) you want more of it. On the supply, if you can charge more and keep selling it, you do. With health care, someone is paying for it but they are not the ones making the price to service decision. That decision process has to be put back into the hands of individuals. You want it? You pay for it.
Government involvement is a factor, major in my opinion, of rising costs. You do not cure a problem with more of the problem. Government is messing up the health care marketplace. Let's not let it screw it up even more. It is time to remove restrictions or bias via tax code.
It is time to rethink how we use the courts to regulate healthcare. There is an area where a revolution needs to occur. Risks of health care need to be placed on the clients and not the providers. If you want a guarantee in medicine, buy your own insurance. Do not make that an automatic cost of healthcare which all patients must bear. Make costs of insurance against risks, including medical errors, an option for consumers to pay for. This will be a means to bring lower cost to people so they can afford healthcare.
It is fine to educate people about risk, costs, and benefits. Individuals can make their own decisions based upon such. Governments, despite what some people preposterously think, do not look out for individuals. They look out for groups, especially those which gets them elected. Government's intrusion is a lose of freedom which is people being seen as individuals. It is not OK for people who think they know best for everyone to intrude into private decisions.
There are times where government intrusion into health care, when you treat humans as a herd, are reasonable. Such would be mass vaccinations to stop disease transmissions. There has to be a high risk that individuals can be infected through no fault of their own to do such. Here you are protecting individuals against others.
Never should government intrude into private health care decision of an individual to protect them against themselves. That is blatant elimination of freedom, one which needs to be protected via an amendment to the constitution as another limitation of government. A right to privacy should be respected as a basic liberty and that has to include one's body.
--------------------------
The cost of medical services is way out of whack. Government intrusion with laws affecting the market place are much to blame. As more federal laws dealing with health have increased, so have market prices risen. It is predictable that as supply and demand cost are separated, prices will rise. In other words, if you do not have to pay for something (it is free or low price) you want more of it. On the supply, if you can charge more and keep selling it, you do. With health care, someone is paying for it but they are not the ones making the price to service decision. That decision process has to be put back into the hands of individuals. You want it? You pay for it.
Government involvement is a factor, major in my opinion, of rising costs. You do not cure a problem with more of the problem. Government is messing up the health care marketplace. Let's not let it screw it up even more. It is time to remove restrictions or bias via tax code.
It is time to rethink how we use the courts to regulate healthcare. There is an area where a revolution needs to occur. Risks of health care need to be placed on the clients and not the providers. If you want a guarantee in medicine, buy your own insurance. Do not make that an automatic cost of healthcare which all patients must bear. Make costs of insurance against risks, including medical errors, an option for consumers to pay for. This will be a means to bring lower cost to people so they can afford healthcare.
QUOTE(Gray Seal @ Mar 10 2008, 10:35 AM)
Freedom will be tromped upon if you had your way, BoF. If it is good with you, it should be mandated to everyone.
No, we are talking about kids, who do not have the power to make their own medical decisions.
The Bush administration has probably compromised your freedom more through national security measures than a hearing screen would ever do.
QUOTE(NebraskaMom @ Feb 21 2008, 08:50 PM)
I have yet to have a baby that I could not determine if they could hear within a normal range by 6 weeks just by simple observation. By 6 months, I honestly do not see how any parent could miss a significant hearing loss. However, given the state of today’s society, I am sure there are some parents who are less observant. Does that give the state the right or the obligation to step in for all parents?
How do you define normal hearing range?
Normal hearing range is from 20 to 20,0000 hertz. I don't think parents can determine this without the tools an audiologist uses.
http://hypertextbook.com/facts/2003/ChrisDAmbrose.shtml
QUOTE(Gray Seal)
Freedom will be tromped upon if you had your way, BoF. If it is good with you, it should be mandated to everyone. It should not be a call of government to make personal, private, decisions. Medical care is a paramount private decision process. Never should an individual's private health problems be a concern of government.
\I'd say that's downright specious.
BoF is right and the argument in I think of two level.
1. Lack of health care has distributed societal cost. Infectious disease is the most obvious and has the most restrictive consequences (up to and including forced quarrantine) but even non-infectious disease cost the economy and tax-payers billions.
It's the same argument that mandatory car insurance laws rest on.
2.
Children deserve health care despite what their parents might think. Until reaching the age of majority no one should be denied necessary care simply because the parent is irresponsible.
The fact is government has not driven up health cost. American costs are higher than the rest of the world even as our governmental intrusion is lower.
We'll have to blame another boogey man.
QUOTE(BoF @ Mar 10 2008, 07:35 AM)
We are all suffering the ills of high gasoline prices. Maybe you should get a vehicle that consumes less gas. If a three hour round trip and fast food are the biggest inconvenience you have in your life, you will be doing well.
Honestly BoF, try to read more carefully. I am not talking about my family. I was speaking about another family in another state. BTW, their family is stuck in a full-size van since there are no fuel efficient 9 passenger vehicles yet.
If you can hear a whisper, your hearing loss is not severe. The ACLU is already supporting the right to opt out of screening so states will undoubtedly be facing more litigation which will cost taxpayers even more.
Also, perhaps you missed the part about the research does not show any improved outcomes with this particular screening. There is no research to back up its effectiveness. If you don't trust the link I provided, please take the time to find research to disprove me before you give more opinions.
I happen to live in a city close to medical care. I had one son's hearing tested (an older child-not a newborn done with electrodes measuring brainwaves) just because he seemed to hear less well than the others. I was told he was within normal range and did not need treatment. Last summer I took one son to an optometrist because he thought might need glasses. He did not.
The difference is I made the decision. I chose who would examine my children, where and when it would be done and whether or not it was necessary. I also paid the bill personally.
It is my decision to make not the state's decision.
When should government be in charge over children and not parents? That seems to be rub to me.
Kids do not have the power to make medical decisions but their parents do, unless they are orphans.
Parents should be responsible for their minors. Reproduction is another area where government needs to kept at arms length which should include health care. Parents should be able to make decisions for their own children's medical needs just as they should be able to decide upon their own. It should be a fundamental limitation on government to not intrude into a family's life. We should have an amendment to address and strengthen the right to privacy in this area.
So you wish for the majority to identify what healthcare is appropriate for all families and the children? Disagree with the majority and you are irresponsible?
If parents are irresponsible, have means to identify it and take the children from them. Are you submitting such irresponsible parents should remain parents, just come seize the children when necessary for medical purposes? (This idea of irresponsible parents has gotten a little too far in its intrusion into families already. Grounds for investigations need to be more grounded than they currently are. On top of that enforcement is arbitrary. But that is another discussion.)
Make it possible for lower cost healthcare to exist and people will use it. It can be done via the marketplace if we get government regulation and courts out of the way.
------------
There needs to be a line where government is limited. I am making my case for where that line is. You have stated where you should government should intrude. Where would you (BoF or turnea) say government should not be able to intrude?
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Government intrusion into healthcare is huge. With torts in our courts(which is government), low cost medical care is illegal. Government heavily regulates the insurance industry. Government offers subsidies depending on how you get your health insurance. Where is the lowering of government intrusion you speak of?
------------
Mandatory car insurance is there to protect other people's property not your own. The aspect of insurance to cover your own loss is not mandatory (at least not in Illinois). This should be a model for when government can intrude into an individual's health: when your health affects another person's health then it is a concern of government.
------------
Kids do not have the power to make medical decisions but their parents do, unless they are orphans.
Parents should be responsible for their minors. Reproduction is another area where government needs to kept at arms length which should include health care. Parents should be able to make decisions for their own children's medical needs just as they should be able to decide upon their own. It should be a fundamental limitation on government to not intrude into a family's life. We should have an amendment to address and strengthen the right to privacy in this area.
So you wish for the majority to identify what healthcare is appropriate for all families and the children? Disagree with the majority and you are irresponsible?
If parents are irresponsible, have means to identify it and take the children from them. Are you submitting such irresponsible parents should remain parents, just come seize the children when necessary for medical purposes? (This idea of irresponsible parents has gotten a little too far in its intrusion into families already. Grounds for investigations need to be more grounded than they currently are. On top of that enforcement is arbitrary. But that is another discussion.)
Make it possible for lower cost healthcare to exist and people will use it. It can be done via the marketplace if we get government regulation and courts out of the way.
------------
There needs to be a line where government is limited. I am making my case for where that line is. You have stated where you should government should intrude. Where would you (BoF or turnea) say government should not be able to intrude?
------------
Government intrusion into healthcare is huge. With torts in our courts(which is government), low cost medical care is illegal. Government heavily regulates the insurance industry. Government offers subsidies depending on how you get your health insurance. Where is the lowering of government intrusion you speak of?
------------
Mandatory car insurance is there to protect other people's property not your own. The aspect of insurance to cover your own loss is not mandatory (at least not in Illinois). This should be a model for when government can intrude into an individual's health: when your health affects another person's health then it is a concern of government.
------------
QUOTE(turnea)
The fact is government has not driven up health cost.
So it is a fact that government has not driven up health costs? A profound statement which is provable by what means?
QUOTE(NebraskaMom @ Mar 10 2008, 12:14 PM)
Also, perhaps you missed the part about the research does not show any improved outcomes with this particular screening. There is no research to back up its effectiveness. If you don't trust the link I provided, please take the time to find research to disprove me before you give more opinions.
Honestly, NebraskaMom, I think you ignore what does not promote your own cause.
This is from the link you provided.
QUOTE
If congenital hearing loss is not recognized and managed, a child's speech, language, and cognitive development are often severely delayed.
<snip>
Despite these concerns, the consensus of multiple organizations that develop children's health guidelines is that the potential benefits of universal newborn hearing screening outweigh its adverse effects.7 Currently, 37 states and the District of Columbia have enacted legislation requiring that hearing screening be performed on all newborns in hospitals and birthing centers (Table 3).24 Additional resources for physicians and patients are provided in Table 4.
<snip>
Despite these concerns, the consensus of multiple organizations that develop children's health guidelines is that the potential benefits of universal newborn hearing screening outweigh its adverse effects.7 Currently, 37 states and the District of Columbia have enacted legislation requiring that hearing screening be performed on all newborns in hospitals and birthing centers (Table 3).24 Additional resources for physicians and patients are provided in Table 4.
http://www.aafp.org/afp/20070501/1349.html
QUOTE(BoF @ Mar 10 2008, 12:36 PM)
This is from the link you provided.
http://www.aafp.org/afp/20070501/1349.html
QUOTE
If congenital hearing loss is not recognized and managed, a child's speech, language, and cognitive development are often severely delayed.
<snip>
Despite these concerns, the consensus of multiple organizations that develop children's health guidelines is that the potential benefits of universal newborn hearing screening outweigh its adverse effects.7 Currently, 37 states and the District of Columbia have enacted legislation requiring that hearing screening be performed on all newborns in hospitals and birthing centers (Table 3).24 Additional resources for physicians and patients are provided in Table 4.
<snip>
Despite these concerns, the consensus of multiple organizations that develop children's health guidelines is that the potential benefits of universal newborn hearing screening outweigh its adverse effects.7 Currently, 37 states and the District of Columbia have enacted legislation requiring that hearing screening be performed on all newborns in hospitals and birthing centers (Table 3).24 Additional resources for physicians and patients are provided in Table 4.
http://www.aafp.org/afp/20070501/1349.html
I find this unconvincing for testing of the general population.
The original study was done in Atlanta. It found that approximately 1 in 1000 children aged 3 to 10 have hearing loss. Of these, 50% had severe conditions other than hearing loss or low birth weight.
Original Study
QUOTE
In addition, 50 (29%) of the 173 children had at least one other developmental disability (i.e., mental retardation, cerebral palsy, or vision impairment) and 17 (10%) had been very low birthweight (less than 3 lbs, 5 oz {less than 1500 g}) infants.
So we are talking about 1 in 2,000 children hear that don't have other outward signs that something is wrong. Plus, if the problem with hearing loss is delayed development, I would think that vision impairment, mental retardation or cerebral palsy may be larger hurdles to development and may have skewed the results. I'm not sure how much "early treatment" of hearing loss would help these conditions.
The other weird thing is that those with these "other" conditions, who were screened as infants, did not have an earlier detection date than the general population. This indicates that early testing has no public health benefit at all (although it obviously costs money). That alone should be enough to second guess the decision to screen all children.
Another argument against this is that the acceptable false positive range is 3%. Detection and Intervention This was footnote 3 from BoF's linked article, the one that they used to justify the importance of early detection (under six months). So in order to catch 1 in 1000 (may be as high as 3 in 1000) hearing problems, we will accept a false positive rate of 30 in 1000.
QUOTE
The methodology used in screening should have a false-positive rate, ie, the proportion of infants without hearing loss who are labeled incorrectly by the screening process as having significant hearing loss, of 3%. The referral rate for formal audiologic testing after screening should not exceed 4%
So we know that the actual rate is less than 1/2 of 1%, but we will refer up to 4% for followup testing. All because this is more cost effective than later treatment?
Now why would the medical community come up with such guidelines? Well, they hint at it in their report:
QUOTE
It is anticipated that there will be increased demand for qualified personnel to provide age-appropriate identification and intervention services for young infants with significant hearing loss. As a result, there will be a need for the training and education of additional expert care providers.
And we wonder why the costs of medical insurance are rising? We are screening for a condition that affects maybe 1 in 2000 "normal" children (not low birth weight and do not have known contributing factors such as vision loss, cerebral palsy or mental retardation), we are following up with a number that is perhaps 10 times are high as the kids who are actually affected by actual hearing loss and of course we want the costs to be zero.
I find it interesting that although the original link says this one supports the assertion that early intervention helps, this study does not elaborate on why having "necessary intervention initiated by 6 months of age" helps. It does link to a study that claims early intervention helps. Study. Of course, the study was performed on less than 24 individuals, only 5 of which had early intervention (i.e. hearing aids).
QUOTE(Amlord @ Mar 10 2008, 01:46 PM)
And we wonder why the costs of medical insurance are rising? We are screening for a condition that affects maybe 1 in 2000 "normal" children (not low birth weight and do not have known contributing factors such as vision loss, cerebral palsy or mental retardation), we are following up with a number that is perhaps 10 times are high as the kids who are actually affected by actual hearing loss and of course we want the costs to be zero.
Does it surprise anyone that a self-styled conservative Republican would worry about cost, when a "conservative" Republican administration has run up such an enormous deficit?
If we can't bowl people over with NebraskaMom's libertarian concerns, perhaps Amlord's appeal to economics will work.
QUOTE(VDemosthenes @ Feb 23 2008, 10:10 AM)
QUOTE(scubatim @ Feb 22 2008, 10:30 AM)
I am with you, but we also need to keep the health of the general population in mind. For 99% of any medical issues, insurance companies and politicians have no place in the decision making process between a doctor and patient, or even if the patient should decide to consult a doctor. It is that 1%, the pandemics and epidemics that we require some control by our government. Fortunately for us, we don't have very many of those incidents, but to maintain order, I think we would need the assistance of the government.
My huge gripe is that government trying to mandate insurance is limiting of free enterprise since insurance is an enterprise and a business designed to make money. Sure, it shells it out for people who put into the system, but insurance is private and therefore is an American business. It's been a founding tenant of this nation to not muck up private ownership. When the government starts dicating to corporations, we're dealing with facism.
The insurance industry is proof positive of one area goverment does far, far, far better that so-called "free enterprise"- the insurance industry is an adverse industry as far as cost containment of health car costs V-
the insurance industry CAN NOT make money unless it cheats- it has to deny coverage and care in order to make money- if they actually paid for every claim that they actually- the entire insurance industry would go belly up in a week. In fact, one of the largest awards in US history was against Aetna for "routine denial"- deny everyone, and see who fights back- I was a victim of this myself. Aetna denied me care while my wife was pregnant, by routine, every month, and I had to fight them to pay medical bills owed, every month, for a year.
The insurance industry is actually ANTI- capitalist, and corrupt by it's very mission- because of instead of making money by PROVIDING a service, they make money by DENYING a service.
I would have no gripe at all if we ended the insurance industry entirely tomorow and threw every board member of one of those corps in jail for the rest of thier lives tomorow- they certainly deserve it, in spades-
but legislating care is a tricky balance between the public safety of infectious disease and disability that society will most certainly pay, and the rights of an individual to not have care forced on them.
I believe something like the mental health magistrate for commiting those dangerous to themselves or others is in order here.
It provides due process, allows the state and individual to make a case and provide expert testimoney, and tends to "err" on the side of the individual.
QUOTE(BoF @ Mar 10 2008, 11:18 AM)
QUOTE(Amlord @ Mar 10 2008, 01:46 PM)
And we wonder why the costs of medical insurance are rising? We are screening for a condition that affects maybe 1 in 2000 "normal" children (not low birth weight and do not have known contributing factors such as vision loss, cerebral palsy or mental retardation), we are following up with a number that is perhaps 10 times are high as the kids who are actually affected by actual hearing loss and of course we want the costs to be zero.
Does it surprise anyone that a self-styled conservative Republican would worry about cost, when a "conservative" Republican administration has run up such ah enormous deficit?
If we can't bowl people over with NebraskaMom's libertarian concerns, perhaps Amlord's appeal to economics will work.
Ya, I think any "cost" issue is pure bunk as an argument in this day and age of 12bn a month being spent on Iraq. There is no credible argument for "we can't afford it" as long as we are spending that kind of money on a giant black hole.
"If congenital hearing loss is not recognized and managed, a child's speech, language, and cognitive development are often severely delayed."
That is a no-brainer. However, it does not require electrodes measuring the brainwaves of newborns to detect hearing loss. There are less intrusive ways of figuring it out in plenty of time to prevent cognitive delays. The research does not show that screening improves outcomes. That is the bottom line.
That is a no-brainer. However, it does not require electrodes measuring the brainwaves of newborns to detect hearing loss. There are less intrusive ways of figuring it out in plenty of time to prevent cognitive delays. The research does not show that screening improves outcomes. That is the bottom line.
QUOTE(NebraskaMom @ Mar 10 2008, 09:14 PM)
"If congenital hearing loss is not recognized and managed, a child's speech, language, and cognitive development are often severely delayed."
That is a no-brainer. However, it does not require electrodes measuring the brainwaves of newborns to detect hearing loss. There are less intrusive ways of figuring it out in plenty of time to prevent cognitive delays. The research does not show that screening improves outcomes. That is the bottom line.
That is a no-brainer. However, it does not require electrodes measuring the brainwaves of newborns to detect hearing loss. There are less intrusive ways of figuring it out in plenty of time to prevent cognitive delays. The research does not show that screening improves outcomes. That is the bottom line.
You cannot determine of the child's hearing is within the 20 to 20,000 hertz range without proper equipment.
Who gave you permission to set a bottom line, except perhaps to your own satisfaction?
QUOTE(BoF @ Mar 10 2008, 08:56 PM)
Who gave you permission to set a bottom line, except perhaps to your own satisfaction?
Who gave the state permission is more to the point? Is it really an issue of state concern? There is more than one accepted method of hearing testing.
I repeat- there is no research showing that newborn hearing screening improves outcomes. If you can find any study showing that newborn hearing screening has improved cognitive outcomes, show it to me. Treatment is being implemented within a similar time frame as before this fancy, expensive, intrusive mandatory screening. Anyway hearing problems are not all at birth. Some hearing loss takes place later.
Screenings can cause a false sense of security. Go read the sites addressed to physicians. They all plainly tell the physicians not to rely on the newborn screenings. If individual rights weren't so serious to me, the whole thing would be funny.
QUOTE(NebraskaMom @ Mar 12 2008, 07:04 PM)
Go read the sites addressed to physicians. They all plainly tell the physicians not to rely on the newborn screenings. If individual rights weren't so serious to me, the whole thing would be funny.
You have a habit of telling people to read specified and unspecified things that support your opinions, but name a site and I'll look at it. I hope it will be as easy to debunk as John Gatto.
QUOTE(BoF @ Mar 10 2008, 02:18 PM)
QUOTE(Amlord @ Mar 10 2008, 01:46 PM)
And we wonder why the costs of medical insurance are rising? We are screening for a condition that affects maybe 1 in 2000 "normal" children (not low birth weight and do not have known contributing factors such as vision loss, cerebral palsy or mental retardation), we are following up with a number that is perhaps 10 times are high as the kids who are actually affected by actual hearing loss and of course we want the costs to be zero.
Does it surprise anyone that a self-styled conservative Republican would worry about cost, when a "conservative" Republican administration has run up such an enormous deficit?
If we can't bowl people over with NebraskaMom's libertarian concerns, perhaps Amlord's appeal to economics will work.
I have never claimed that the Bush administration is fiscally conservative. The explosive expansion of discretionary spending doesn't lie.
But this is not a federal issue. This is a local and state issue where the government is intruding into the medical decisions of families.
My argument is not only that this costs too much. It is also that the government will not only allow excess waste, it demands excess waste. It treats potentially 30 kids per 1,000 when only 3 are hearing impaired.
This is the type of thing that will happen with a government run health care plan: the government will be expected to treat every little ailment and denying care to anyone will cause an uproar. This is guaranteed to drive costs through the roof as people demand treatment for things they only suspect they have. The government will allow this as it grows the bureaucracy. We'll continue to treat brain dead people long after they've left this world in all but body. We'll waste countless dollars keeping the terminally ill alive. We'll screen for every possible disease or disorder and treat more people (and eventually insist on treatment) that don't have ailments.
We've seen examples of children being forced to take these screening tests for non-communicable (i.e. not a danger to others) ailments, for injuries that turn out to not be severe, and for genetic disorders (again, not a danger to the community at large). The intrusion of government into the lives of private citizens "for their own good" will never stop unless we put our foot down and say enough is enough.
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