Posted on 02/24/2017 2:34:09 AM PST by markomalley
An irate man contacted me recently to complain he’d been turned down for back surgery because he’s a smoker.
“It’s just not right,” said the Charlotte man, who suffers from chronic hip and leg pain. “I need this surgery. It’s to the point where I can’t walk around the block with my dogs.”
He acknowledged smoking is a “bad habit,” but after 35 years, he’s not sure he can quit. And he doesn’t think he should have to.
(snip)
Spector said it’s part of a national trend for doctors to run down a checklist of behaviors in preparation for elective surgery. Before spinal fusion, Spector said he might tell a patient: “Listen, I want you to stop smoking, but if you can’t stop smoking, at least cut it in half. A two-pack-a-day smoker is going to have a higher risk (of complications) than a two-cigarette-a-day smoker.”
(snip)
At OrthoCarolina, Spector said doctors agree that all patients who register for the bundled payment plan must go through “surgical optimization” so they’re as healthy as possible before surgery. At some point, insurance companies may even begin to refuse to pay for elective surgeries on smokers.
(Excerpt) Read more at macon.com ...
In this case you have an individual who is a high risk for surgery. Take away the insurance companies and I still don't see why the doctor would want to take on the risk of liability on his own. Because of the patient's history of abusing his health, if he dies on the operating table or has complications following surgery then the doctor is still liable to be sued.
Read the article. "If you're doing surgery, you're trying to get the bones to unite, and if you don't have good blood flow, the results aren't as good." Smoking restricts blood flow.
Agreed with your comments. Two things to consider:
So while you make eminent sense when talking about governments gathering increased excise taxes being gathered while simultaneously paying out less for social security / pensions, I know of no cases where the increased taxes are being placed directly in a medicare/medicaid account, much less being funneled to a commercial insurance company to offset their expenses.
Likewise, I know of no linkage between the OASDI fund and the Medicare fund where savings achieved as the result of a smoker's early death are funneled into the Medicare fund. (Or where other pensions that stop paying early as well)
As they say, different colors of money.
Sure.
But consider this: the doctor could remediate the contract for services and then mitigate the residual risk with money:
In a free market world (a/k/a one not overly regulated by government), there are a whole lot of steps to reduce vulnerability and to reduce the potential exposure to risks.
And hugely obese patients? How about COPD patient? How about cancer patient? How about alcoholic that may begin DT’s during recovery?
This is silly. Where do you draw the line. Nonsmoker here but nobody is in perfect health and anyone can crash, have complications etc from any surgery, tiny or big.
You sign a permit stating what can happen to you from a particular surgery; read it before you undergo the knife.
Or he could walk away from it. Why, in any world, would you accept risk when you don’t have to without any way of mitigating it?
Correct, however, if you check the price schedule for your available plans, before commie care, you had age, sex, and zip code. Pre existing conditions were typically handled by either exclusion or delay, meaning you would not get a policy, or they would not pay for treatment associated w/your condition for the first year.
So if there is no scaled pricing plan based on condition, any actuarial computations made to that effect are irrelevant, other than to define who is excluded from a policy.
Post commie care, it was by statute that the gov indicated policies w/preexisting conditions could be charged 150% of base policies, and those without “wellness” (smokers, obese) could be charged 130%. Again, no actuarial computation driving the actual price.
It’d make perfect sense to me to have actuarial computations drive the cost for all lifestyles. If it’s based on that reality, it’s simply a market price. I have absolutely no prob w/that - as long as you run that calculation on all lifestyles, not just the ones you dislike!
Per the distribution of tax money, that is an abuse of the taxation to begin with. It is simply a cash cow.
On a population basis, as with social security, dying earlier ultimately means less expense so Medicare and Medicaid benefit from smokers just like SS does. This is because payroll taxes include medicare and you are taxed 2.9% on wages, with the employer covering half of it (so you only see a 1.45% draw from your check). Medicaid is partially covered w/state income tax and partially reimbursed by the feds.
You are right about insurance companies not being reimbursed through tobacco taxes. To me this is simply an abuse of tax authority. I mention it as an argument in response to the argument of “the cost of smokers”. I.e., if you are worried about that cost, then, INSTEAD of using that cost as the basis for excluding them from treatment, you SHOULD argue that tobacco tax be funneled to either insurance companies or hospitals.
And yet that isn’t completely true. There are plenty of smokers operated on who do just fine. Anytime surgical results go south they always look for something or someone to blame. Example operating on people over sixty five doesn’t have as good an outcome as operating on someone younger.
Watch out folks this is another step along the way to denying health care to those who are too old. They will mandate euthanasia
Settlement? That means doc and hospital were sued for doing something wrong. How is that the smokers fault?
While I agree with all you say, I am not against insurers, in any insurance arrangements (whether directly by the individual or as part of an employer/union plan) simply charging a higher premium to a smoker. That would be very much supported by the statistics, and it is statistics that insurance actuaries base their rate-making judgements on, not the individual.
I would think an individual joining an HMO type plan, like a Kaiser plan, could meet the same smokers-rate premium argument.
For the sake of the country, perhaps they should refuse to operate on liberals.
Starve a liberal, feed a free country.
Let a doctor refuse to operate on a gay patient with HIV, and see what happens.
>>Settlement? That means doc and hospital were sued for doing something wrong. How is that the smokers fault?
Naive much?
>>In a free market world (a/k/a one not overly regulated by government), there are a whole lot of steps to reduce vulnerability and to reduce the potential exposure to risks.
Also in a free-market world, a doctor who believes a patient is too high risk for a given procedure, should be allowed to not do that procedure - the patient can go find another procedure.
Let me try that again:
Also in a free-market world, a doctor who believes a patient is too high risk for a given procedure, should be allowed to not do that procedure - the patient can go find another doctor.
By all means.
Having said that, I will take on high-risk work in some cases. But the customer will pay me dearly for accepting that risk. High risk does not mean probable failure...it just means that there are a lot of variables that must be managed to keep the project from going pear-shaped in a hurry.
Can't imagine that there aren't doctors who would have similar attitudes.
Death by
Smoking 7x
Alcohol 7x
Both 40x
Now you see your future.
Which means you support the nanny state.
You’re preaching to the choir with me. It was the OP who was for freedom... sometimes.
You are grossly mistaken if you think the bureaucrats in the swamp ever think of or care for the taxpayers. They don’t even give lip service to the taxpayers.
They do give lip service to the recipients of their programs. But lip service is all it is. In state government, maybe 1 in 100 bureaucrats ever really thinks about what is best for anyone except the bureaucrats and bureaucracy.
I suspect it is 1 in 1,000 in the Federal swamp.
And when the rare bureaucrat expresses something that would benefit the program recipient but hurt the bureaucracy, that person can expect to be ostracized and shunned
What is the ACA really about? Is it really about the poor uninsured? No way. It is about elitist knowing what is better for the rest of us than we do and then building a self-serving bureaucracy to control us and see how high we jump when they issue a change to a regulation.
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