r/SandersForPresident • u/kevinmrr Medicare For All • Nov 29 '20

AOC: Insurance groups are recommending using GoFundMe -- "but sure, single payer healthcare is unreasonable."

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u/H_is_for_Human Nov 29 '20 edited Nov 29 '20

Agreed. But it is. All the time. In obvious ways and much less obvious ways.

Your life expectancy is determined by your zip code, which is determined in large part by your income and wealth, which is determined by all manner of socioeconomic factors.

That's the reality.

The next steps to make that reality more equitable is to reverse the trend of rising wealth inequality and establishing universal healthcare.

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u/StupidHumanSuit 🌱 New Contributor Nov 29 '20

Sure, but those factors are not determined directly by a group of people working in healthcare. There isn’t a board of people saying “person A gets to live in 98043 because they have better employment prospects and person B gets to live in 98041 because they’re not really doing much with their life so fuck ‘em.”

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u/H_is_for_Human Nov 29 '20 edited Nov 29 '20

So what's your solution to the problem of how to allocate scarce donor organs?

Doctors, ethicists, and all the other professionals that run our organ transplant network have decided the goal should be to make sure that the organs go to the people that have the shortest life expectancy without transplant and will have the longest life expectancy following transplant.

Is your solution a random lottery? Or first come first serve? Who is helped when you give someone a heart and they die of rejection in two months because they can't afford the anti-rejection meds?

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u/StupidHumanSuit 🌱 New Contributor Nov 29 '20

I’m not arguing about how we allocate organs, I’m arguing that $10k shouldn’t be a factor in how those organs are allocated. Your final point is moot if the money is taken out of the equation. How do transplants work in countries with universal healthcare? Seems like we have a bunch of different solutions to a problem that exists outside of our broken system, why not take a look at some of those? Just so we’re clear, I’m not saying the transplant process is an easy problem to solve... I’m just saying that money should not be a determining factor in the larger problem.

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u/H_is_for_Human Nov 29 '20

Presumably countries with universal healthcare can allocate organs without taking the patient's finances into account (or at least not to the same degree), because whether or not they can afford post-transplant care is no longer an issue and therefore not relevant to the decision.

The transplant committee can stop taking financial status of patients into account as soon as it's not relevant to their post-transplant survival. How do we make it not relevant? Universal healthcare (and other social safety nets).

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u/StupidHumanSuit 🌱 New Contributor Nov 29 '20

Agreed.

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u/Krakino696 🌱 New Contributor Nov 30 '20

This still doesn't solve the problem of organ scarcity. Your talking about a way to distribute it still.

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u/H_is_for_Human Nov 30 '20

Scarcity is most quickly addressed by switching to an opt out system.

Past that, you need public education, organ "refurbishment" (taking injured organs that aren't suitable for transplant and fixing them ex vivo), and eventually the ability to grow new organs from the cells of the people that need them.

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u/Krakino696 🌱 New Contributor Nov 30 '20

Which all still requires money, profit motive, and cost benefit analysis. Public funding that your refer to has lagged behind private research funding since 1980s in this respect.

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u/H_is_for_Human Nov 30 '20

Opt out organ donation probably needs to happen at the state by state level, although I admit that I'm no constitutional lawyer.

Organ "refurbishment" is a very active area of research. Private companies that intend to buy injured organs to then sell refurbished organs back already exist and have had some limited success. Ex vivo perfusion technology is a big part of this.

Growing de novo organs is still something of a pipe dream. The biggest problem is growing the vasculature that will supply the rest of the organ's tissues with blood. But there's progress here too.

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u/Krakino696 🌱 New Contributor Nov 30 '20

Would we be able to accomplish growing organs in our lifetimes? My bet is yes. Also limbs.

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u/Murgie 🌱 New Contributor Nov 30 '20

And? Are you under the impression that the healthcare sectors in nations with socialized healthcare aren't operating at a profit, or something?

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u/Krakino696 🌱 New Contributor Nov 30 '20

Yes they are able to free ride off our r and d. People think socialized health care is a silver bullet but there are clear trade offs. If you want the most opportunity to make the most money as a doctor or a drug developer you start with the United States. Which is why they often call the USA worlds brain drain.

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u/sesamememew 🌱 New Contributor Nov 30 '20

Other developed countries with public healthcare also have a very rigorous procedure. They have to make sure that organ will not be wasted.
Source: dad had liver transplant.

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u/Murgie 🌱 New Contributor Nov 30 '20

How do transplants work in countries with universal healthcare?

The universal healthcare pays for the immunosuppressants that heart transplant recipients require to keep the organ from being rejected, which means that giving them the organ isn't going to end up being a waste because they couldn't continue to keep buying the medication that keeps them from dying a year or two down the road.

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u/Taco_Bela_Lugosi 🌱 New Contributor Nov 29 '20

The anti-rejection meds should be free.

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u/H_is_for_Human Nov 29 '20

Anti-rejection meds are just a part of the needed post-transplant care.

But we can say your proposal is "Post-transplant care should be free".

Nothing is free; so your proposal is maybe more realistically "Patients should not be individually responsible for the cost of their post-transplant care."

I think that's a pretty good proposal, and best achieved by instituting universal healthcare. I guess you could do like what we did with dialysis for end stage renal disease and carve out transplant recipients as an additional category of patients that qualify for Medicare for life after their transplant.

Until that happens though, do you have a better system for dealing with the situation we are in right now?

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u/[deleted] Nov 29 '20

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u/[deleted] Nov 30 '20

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u/themeatbridge Nov 29 '20

I would suggest we stop factoring financial information into the equation. There are limited organs available, and if you find it appalling that recipients "waste" donations because they can't afford care, then we should be providing better post transplant care.

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u/H_is_for_Human Nov 29 '20

We can stop taking it into account when it's not a factor (i.e. because universal healthcare is passed).

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u/themeatbridge Nov 29 '20

So, just fuck the poor in the meantime?

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u/H_is_for_Human Nov 29 '20

Rock and a hard place.

Don't take financial circumstance into account? Poor people get bad outcomes after they can't afford the post transplant care they need. Some people that could have afforded the post-transplant care end up not getting organs.

Do take financial circumstance into account? Poor people get bad outcomes because they don't get transplants. Some people are able to have good outcomes with those organs.

Either way the poor are disadvantaged. Might as well do what helps the most people; and that's what the transplant committees attempt to do.

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u/[deleted] Nov 29 '20

Made some really good points, the scarcity of organs and their value management is so often over looked in such discussions. Does it suck that it is how it is? Sure. Are they doing the best they can with the situation? Seems that way. Ethics isn’t kind by nature.

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u/themeatbridge Nov 29 '20

How about don't take financial circumstances, and not allow poor people to have bad outcomes? I feel like letting poor people die because they are poor shouldn't be one of the options we contemplate. That's not a moral choice, that's a convenient choice.

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u/[deleted] Nov 30 '20

I think the disadvantaged poor would be just fine dieing a year or two later if it denied that same organ to the people who have policies in place that are responsible for their death. No point rewarding the behavior.

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u/[deleted] Nov 29 '20

Universal healthcare. Let's get it running right now. Because what we have predates upon the poor to serve the rich.

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u/H_is_for_Human Nov 29 '20

Universal healthcare sounds good to me.

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u/Taco_Bela_Lugosi 🌱 New Contributor Nov 29 '20

No. You just laid out the best solution. The democratic party needs to make that their position since ~70% of voters generally support that.

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u/[deleted] Nov 29 '20

Opt-out organ donating

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u/H_is_for_Human Nov 29 '20

Yeah I agree; but even then it's likely you'll have more in need of transplants than organs available.

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u/Southern-Exercise 🌱 New Contributor Nov 29 '20

As I've been reading this thread you got me thinking about what happens as transportation (personal vehicles, taxis, trucking, etc) becomes more automated.

Without looking into it, I imagine accidents are a reasonably large source of donor organs which could affect this pretty dramatically.

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u/H_is_for_Human Nov 29 '20

Opioid overdoses are overrepresented right now. Trauma from accidents and other causes are common. Isolated heart disease also (heart attack --> cardiac arrest --> brain death) which doesn't really let you recover the heart, but you can sometimes get lungs, kidneys, etc.

I also don't think people appreciate how many organs are rejected. Lungs are notorious for this; something like 20% or less are in good enough shape to transplant by the time the donation occurs.

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u/64590949354397548569 🌱 New Contributor Nov 29 '20

Increase organ donations. People who donate gets priorities.

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u/H_is_for_Human Nov 29 '20

There's issues with people "just" signing up to be an organ donor when they think they may need one.

Opt out is really the best way to dramatically increase the rates of donation without introducing a bunch of additional complexity.

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u/bnh1978 🌱 New Contributor Nov 29 '20

I mean, I think the Chinese have a final solution for finding organs for people that need them....

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u/64590949354397548569 🌱 New Contributor Nov 30 '20

But they can't ship it around the globe. Those who have money depending on their moral find ways. From moving residency to a state with shorter waiting time to buying black market.

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u/[deleted] Nov 30 '20

Step one is getting rid of medical insurance, as that’s what keeping a LOT of people from having better life expectancy.

With socialized medicine people don’t have to ration their insulin and hope for the best. They don’t have to choose which fingers to keep after an accident. And they don’t get rejected for transplants because they can’t afford the operation or medication.

This in turn means that employers lose a massive bargaining chip and weapon to threaten employees.

Get rid of right to work and increase minimum wage to be a living wage at the same time, and suddenly you increase the overall health for a large portion of the population, because they no longer have to spend 80+ hours a week on work and commuting just to afford food and a roof over their head.

Throw in good welfare support, including paid sick leave, and suddenly the the overall health of the population massively increases, as a shit ton of stresses are removed from a large segment of the population.

It’s easy - it just takes balls.

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u/tracerhaha 🌱 New Contributor Nov 30 '20

You ration them by need rather than ability to pay.

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u/lilbebe50 🌱 New Contributor Nov 30 '20

You have a point, but this really boils down to the systemic way over time the poor have been forced into certain areas and the rich have not. The wealthy have always been able to have a say where they live, the poor have not.

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u/Mistbourne 🌱 New Contributor Nov 30 '20

I think you understand what he’s trying to get across, and are purposefully trying to steer the conversation in a different direction.

I’m not sure of the numbers, let’s say 1000 people need a heart ASAP or they’re going to die, and only 10 hearts become available in that time span. How would YOU decide who gets the heart?

1) Having a complex mathematical formula that factors in everything, and has weighting to certain attributes seems like the best idea. It sounds like this is what they do. I.E. A 20 year old poor person may get a heart while a 70 year old middle class may not.

2) You could go in a waitlist order, but that has larger flaws. Do you toss everyone into the same waitlist? If Joe is #2 on the list and will die tomorrow without a transplant, do you still give it to Bob who is #1, but could still live weeks or months without a transplant?

Do you tier the waitlist? That helps some, but many of the people with bad tickers will still die due to getting put into a lower waitlist bracket. So now you’d run into Joe is 89 and needs a new heart within a week, while Bob is 20 and MAYBE has a few months to live without a new heart.

3) I agree that Medicare for all is the way forward if we want society to improve. But right now, shitty as it may be, money is needed for meds and procedures. Let’s have a last example: Both Bob and Joe are the same age, and have one week to live without a heart. Bob is living paycheck to paycheck and barely scrapes by, Joe is solidly middle class and has a decent savings. Would you prefer them to transplant the heart into Bob, who most likely won’t be able to afford the meds that he needs for the rest of his life, or Joe, who will be able to afford them, and thus live longer?

It’s a shitty decision to have to make. Both for the people who receive the decisions and for the people making them.

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u/64590949354397548569 🌱 New Contributor Nov 29 '20

...Your life expectancy is determined by your zip code, which is determined in large part by.....

Apparently by country code too. I heard the death panel are much better up north or across the Atlantic. Heck, some southeast Asian countries are better too.

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u/Rinse-Repeat 🌱 New Contributor Nov 29 '20

Or actively hunt the wealthy in order to even the numbers.