I was curious until I read the examples-

in the U.S. you do have to achieve and maintain sobriety for a minimum 6 months to obtain a liver transplant, although individual transplant centers vary somewhat in their requirements. I lost my spouse to hep C liver disease waiting for a transplant, and learned about the huge disparity between organ availability and patients needing organs. Transplant centers also require people to stop smoking because anti-rejection treatment makes it easier for cancers to develop.

As to IVF, I have generally considered this to be a "lifestyle" treatment which should NOT be covered by insurance, but even so there are definitely risks when very obese women become pregnant. I don't think this article is talking about punishing people for their choices, it's about weighing in behavioral components as part of the medical risk for the treatment that is sought.

Well maybe the insurance industries should take a hard look at approving covering medication that helps people to stop smokinginstead of approving medication to get it on with the mis/wife by approving Viagra and other such pills.

What next, withhold foot treatment to anyone who walks ?

you have got to be kidding me. They want to deny non-emergency treatment for people who they have taken a moral objection to? I can't even believe this is something being considered. Is this so when they do statistical surveys they, who ever they are, can show how awful these people are and how deadly these health issues are? Are they denying treatment for people so they can die sooner than later and decrease the surplus population? We live in strange times people. I pity those that come after us if these types of justifications continue unchallenged. What is also scary is that everything these days has a monetary value to them and if anything is not deemed profitable it is demonized, marginalized, and therefore nullified and eliminated. Let us not forget that these are people, people who for whatever reason need medical attention. I never thought it would come to the point where someone could judge who I am and whether or not I deserve medical treatment. then again I guess society needs someone to blame for something and as they, who ever they are, goes down the list of what is right and wrong and widdles humanity away they will finally get to that master race of people some seem to desperately need.

only the pretty boys and the pretty girls deserve help...think i'll have a drink...and a smoke...roll another one ...just like the other one...

Is this the equivalent of the death panels we are hearing about with Obamacare? I can see not performing elective procedures, but if it is a health issue it should not be denied regardless off weight or smoking.

I can understand the frustration that made some doctors vote to withhold treatment to some patients because of their lifestyle or, at the very least, require said patients to make some kind of effort to change that negative lifestyle.. As a person who CHOSE to smoke for 40 years and then 7 years years ago, after a serious bout of Pneumonia, ending up with permanently damaged lungs and having to watch my dreams of having a happy, ACTIVE retirement effectively squashed for good! The scar tissue that fills up the majority of my lungs is permanent and I have no one but myself to blame, myself AND the tobacco companies that filled their cigarettes with excessive amounts of addictive Nicotine..

It is not right to put donor organs into a person who has already disrespected their body to the point of destroying it.. There are far too few organs available to waste like that.. It's like Cheney, the ONLY reason he got that new heart was because of his money and I hope he'll be haunted with the fact that by stealing that organ from a younger, more deserving person he effectively took someone's life, however, being Cheney, I seriously doubt if he'll give it a second's thought!

However, all this being said, Doctors are BOUND by an oath that says they cannot turn away from someone needing help.. The only thing they can really do is try to get people to change their harmful lifestyles BEFORE going into surgery.. This does NOT, however, include voluntary services such as 'in-vitro' or plastic surgery, which are 'elective'.. Here the doctor can decide IF they want to help their patients or not and I think they have that right..

Try this perspective. Denying treatment that does not threaten the life of the patient - and that's what they're talking about - is in itself a form of treatment. The doctors are basically saying: "I cannot help you if you will not help yourself. You are the vector."

It makes absolutely no sense to reinforce bad behavior in a patient, when that behavior is what creates the need for medical attention.

We now have mountains of evidence that clearly identify obesity and smoking as outright killers. It is utter foolishness to facilitate or enable a person to continue the very habits that necessitate medical treatment.

It all amounts to who is in charge. If the "boss" smoked or was obese, this would never be in the news. If he/she didn't like watermelon, you would never see them anymore, or would have to pay high taxes to get one.

Stop beating the public up. If you don't like obese people, look the other way. Nobody is forcing you to marry one.
If you don't like smokers, step around them. People have been smoking for years. I don't like them either, but I wouldn't "take them out", which is what people are saying should be done by denying them medical care.

I might not like the way you comb your hair, or that space between your teeth, or how big your feet or ears are, but I wouldn't suggest everyone bully you or condemn you for it.

And as for paying other people's medical costs. You don't pay anymore than they do.
Most of those people are working and paying their own insurance costs.
If the costs are rising, blame it on your government officials. THEY are the ones wasting it away.

One has to ask, what happened to the Hippocratic oath? If they are going to deny treatment to these people, where does it stop? Are people who drink alcohol next, or soldiers wounded in the field? IMO, the moment they start denying treatment to anyone, they should have their medical license pulled for breaking their oath. Years ago, money was the least of a doctors worries, seems today, that isn't the case. Also, who are they to determine who is to get treatmented or not? I gather they feel they rank right up there with the creator. Sorry, just not happy about this.

Kudos to David Walker for getting it. It's hard for me to understand how anyone can balk at the idea that an alcoholic ought to give up drinking before getting a liver transplant, for example.

When you get a credit card, it comes with a credit limit. If you charge more than your limit, the bank says, "sorry, you have to pay some of that balance before we'll loan you any more money." It makes a great deal of sense to me that doctors would say, "sorry, your behavior is the direct cause of these illnesses that you have. Until you change the behaviors that are causing the illness, there's nothing I can do for you."

If we had a truly market-based healthcare system rather than the nonsensical, value-destroying, price-distorting "insurance" mechanisms we have in the US today, we'd probably have similar outcomes. Massively obese people would go broke getting a variety of treatments and would ultimately go to work on the CAUSE of their problems rather than spending all their money treating the symptoms. It's interesting - and for right-wingers especially it creates a painful level of cognitive dissonance - to see that an effective single-payer system and a truly market-based system will converge around some essential principles over time.

Jack Mack,

I "get it". But what I DON'T get, is who the h#ll has the "right" to deny others what they themselves think is THEIR right to have?

You might not have problems today, medical or otherwise, but you have NO idea what you will wake up with tomorrow.

I'd say the best thing for people to do today, is go see the "Wizard" because there is a serious lack of hearts in this world today, unlike 30 years ago.

Why don't we just send them to the gas chambers, those who smoke and overeat, kill them & there'll be no problem. You know smoking is a big industry globally that this country promoted and protected for decades, even now. If they want people to stop smoking, then ban the manufacture of cigarettes. As much as food prices have gone up, eating will soon be a privilege of the 1% and we all know that doctors will always treat someone who pays well.

Jack, you missed the point of the article. Sure, they mention not giving a liver transplant to someone who is a heavy drinker. Heck, that happens in this country a lot too. But the article talks about non-emergency care. It makes no distinction between whether the non-emergency care is related to the perceived vice of the individual. Thus, if you are a smoker and someone rams your car and you end up with a broken arm, this is arguably a "non-emergency" (ie: not life threatening) and thus you may be denied treatment. The fact is that everyone engages in what someone else could term as "destructive" behavior. Thus, it all becomes a matter of what the politicians and bureaucrats decide.

With regards to your last paragraph, you do have some interesting points, although your conclusion isn't necessarily correct. The insurance mechanism, which includes government, has totally distorted our system, not just in the health care area either. The following observation is continuously being proven true: "There is nothing more inefficient than one person spending someone else's money for still another person's benefit!" Let's face it, if you have a runny nose and you have to pay for your own medical care, chances are you are going to ride it out until it goes away. On the other hand, if you know you can go to the doctor and get some meds that may or may not speed up the recovery period and you know you don't have the write out a check and will not receive a bill for the services and meds, you are much more likely to go to the doctor.

This is true all over the place. Does anyone seriously believe that the costs of a college education would be anywhere near where it is if the students were forced to pay for the education immediately out of their own pockets? If you pay for your education out of your own pocket, how likely are you to join a fraternity or sorority, sit around and drink all day partying? If you're not paying for it then there is no skin off your teeth if you goof around. It's called ownership. And it works in all aspects of life. Giving something to someone for nothing is not a way to motivate someone to be the most productive or self-reliant.

SF accountant,

"To be sure, smokers and the obese are a disproportionate drain on a public health system, since they consume more services in relation to other citizens who contribute just as much."

That is a bold statement to make without any proof other then being politically correct in todays' world. Alcohol costs the economy more. True there are medical expenses associated with obesity and smoking but LESS then the costs associated with drugs (alcohol is not seperate from drugs, it is a drug).

Smoking and obesity do not have costly legal implications that drugs do in the forms of courts, laywers, jails and prisons. What are jails, prisons, police, medics and all forms of insurance costing the American people? How much work is boozed up and hung over employees costing America?

However, Americans must have their booze no matter what the consequences are. Why not deny medical assistance for drunk drivers or drug addicts? Why pay for treatment programs for drug addicts? Why pay for injured gang members who pay nothing into the healthcare system nor taxes but most certainly are draining the medical resources of this country?

Lifestyle rationing I remember them calling it. Ration healthcare services to alcoholics, drug addicts, gang members along with the fat and smokers.

Witchrunner, leave it to someone of your ilk to blame it all on the Pres. And as far as your misguided comment re: post-secondary education, you are VERY far afield from what is actually happening in that industry. The colleges and universities are increasing their own costs at a rate that far exceeds what is actually necessary for their maintenance. Retreating into cliched arguments, e.g. that college students "sit around and drink all day partying" is at once idiotic and inaccurate. (makes us wonder if you ever were one...) It is the mark of a true conservative, and the easiest way to spot one, when all we get is a barrage of stereotypes, the superficial, shallow and memorized talking points and a torrent of misunderstood and twisted data.

David Walker,

"We now have mountains of evidence that clearly identify obesity and smoking as outright killers."

We also now have mountains of evidence that clearly identify drugs (alcohol included) as outright killers. What are the moralist doctors and society going to do about that? Hypocritical thinking at its' best to say one "lifestyle" is not treatable but the other is.

" Also: It is utter foolishness to facilitate or enable a person to continue the very habits that necessitate medical treatment."

Why does that NOT apply to all drug addicts? How about extreme sports? Now there is a "lifestyle" that has medical implications. Deny those that choose to do stupid activities like that.

The medical field is full of quacks. They should have left the list open ended and simply had the doctors write in the types of people they really do not want to provide services to and post their names and results online so the patient will have a more fair knowledge of the type of hypocrite they may be trusting their health to. Many of these types of quacks will simply lie to the patient and send them on their way with no treatment and a false sense of they will be better tomorrow.

Should a doctor provide a prosthetic leg to someone that is paralyzed from the waist down?

Doctors are required to make difficult and unpleasant decisions everyday. A doctor must assess the likely outcome of many medical procedures - whether the patient's life is endanger or not. Should a doctor be required to provide a medical treatment if the possibility of successful outcome is extremely low?

This article is NOT about lifestyle choices - it is about providing costly and possibly painful medical treatment that has a low probability of success. Do we, as a society, require our doctors to provide treatment that will likely fail?

Although the article is presented in a slanted manner - presumably to garner more site clicks - doctors have made these types of decisions for centuries. This is nothing new.

So these doctors have decided to play god and decide who to give care to and who to let die. How about those people who have Cushings syndrome and the weight gain that comes with that, are they to be denied testing and medical care just because they are overweight? What about all the other endocrine and hormonal problems? How do these doctors know what is the cause of the person being overweight or obese?

Do these doctors think that because a person is thin that they are healthy? There are diseases that causes folks to be thin too and they are not healthy.

What about people with mental/ psychological disorders like bulemia and anorexia nervosa? Are they to be denied treatment too?

What about people who sunbathe and now have cancers of the skin, are they to be denied treatment too because of their lifestyle choice of browning themselves so they do not or did not use sunblock when they were younger?

How about folks who participate in risky sports and/or those who are supposedly adrenaline junkies? Should the person who drives too fast and break the speed limit not be treated because they should have been driving slower? How about those folks who do rock/mountain climbing or skiing or other sports that carry risk? Should health care be denied young men because of their possible propensity for participating in those sort of risky sport activities even although they know that such participation could lead to serious injury or death?

How about people who work in dangerous jobs like electricians or people who build skyscrapers or work with explosives, chemicals or doctors working with infectious diseases etc should they be denied healthcare too because of their behaviour/lifestyle/ job choice? Should firefighers and people in the Armed Forces be denied treatment because of their jobs? How about police officers? How about cleaners and people in landscaping who breath in chemicals and pesticides everyday...Should they be denied healthcare because of their lifestyle/work choice of putting themselves in harms way? I.e. their style of life is to take risks and/or work in jobs where salaries are probably higher so they can live or do whatev they please/choose.

How about people whose lifestyle is to seek the services of prostitutes and contract a sexually transmitted disease or if the persons are promiscious or are even sex addicts? Should they be denied treatment too? Wouldn't they have contracted their disease through a lifestyle choice of risky sexual behaviour? If it was not through lifestyle choice and the risky behaviour was due to psychological issues if non emergency threatment is denied how can the doctor determine/diagnose whether the it is a lifestyle choice or due to a medical or psychological problems?

How are these judgemental doctors going to decide what caused the person being overweight etc? Wouldn't it be more cost effective for the person to see the doctor during office hours and where teaching etc can take place rather than these persons getting treatment in the emergency room where the cost of care is far more expensive?

By the way there are prescribed drugs that can cause the person to gain weight or have fertility issues, so how are these lifestyle judgementalists going to know what is the cause of these problems if these patients are denied access to healthcare screening in the doctors office?

Didn't these doctors take the Hippocratic Oath or did they take the Hypocritic Oath?

Perhaps these doctors are simply lazy and do not care or want to extend themselves to care enough for their patients to find out what ails them. Perhaps they simply want to collect the payment for the number of patients in their practice although they do not provide any care for these 'lifestyle illness' patients as they have now found a way of denying service/care i.e. not bothering to check these patients out or provide followup care. Perhaps they sooner look after those people who they decide/judge that they are supposedly healthy just because they are thin or they do not have a cough.

Perhaps these doctors simply want that all patients go to the ER first for examination and diagnoses and to make the decision whether the patient has a lifestyle type or some other type of illness, then for the ER to refer those patients whose illnesses are deemed not lifestylesque to them.

On the other hand after a while and after the population is suitably culled of these undesirable people with their supposed lifestyle induced illnesses or activites that lead to or will lead to their untimely death, there will be no need for these doctors services after all.

Wonder when these doctors will let those babies with birth defects die, the ones born of parents who did not have the genetic/endocrine etc testing or subsequent healthcare to treat their illnesses?

Ah that slippery slope to hades.....well greased with good and righteous judgemental intentions......

So....Let the culling of the undesirables begin...... LOL

Peace......

PS... if you are rich the culling i.e. with-holding of medical and psychological care does not apply to you, as you can buy any service and organs you desire no matter your lifestyle..... Hmm LOL

Since recent studies indicate that the United States is becoming or has become the fattest country on earth, then I guess we would be denying millions non-emergency care if we took this route. Children in this country also have obesity and weight problems. Are we going to deny them basic healthcare as well?

I think this route is NOT the way to go. It is unconscionable. What about the oath the medical profession takes? Do we throw that out?

All the money the states received from tobacco company settlements goes to television ads (and whatever else they use it for). None to the people that are addicted to cigarettes. Please don't tell me just quit because it is not the same for everyone. Some have it easy, some hard. Part of that money could be and should be used to pay for Quit aids like patches or gum which is not even covered by most healthcare companies. It is very expensive and it's like a 12 to 14 week regimen. A box of Nicorette gum can run 50 to 60 dollars.

I smoked and finally quit after many, many years. Most of my smoking occurred BEFORE we found out how really bad it was and what was being put into the cigarettes. I tried several times before I was successful. My lungs will never be the same but that is my cross to bear.

I try to keep my weight within normal limits, I no longer smoke, I have always used alcohol sparingly.

It is very easy to be judgmental when you do not have the same vices as others, but it still does not excuse withholding care.

I wonder if they would deny treatment to HIV patients because of the lifestyle causation thing? Penicillen from STD patients because they are probably leading a promiscuous lifestyle? Prenatal care from unwed mothers or women already with children and on welfare? Or mothers to be with known genetic disorders, like mental illness?

Anyway, doubt it would happen in America where there is no "socialized" public medical treatment as in Britain. Just read the article that doctors are complaining because they aren't "rich" or making enough. Many young docs starting out find they need more patients, that's why they agree to HMO contracts.

BTW, I though doctors took this oath to care for and serve the ill-- what's that called--the Hippocratic oath I think. I guess they culd always change that to care for and serve all those who live a healthy lifestyle.

Just wanted to add to that, let's withhold treatment from runners or sportplayers with sprained ankles, pulled muscles, torn ligaments, etc. Hey, they did it to themselves, running those 3 miles a day and all those marathons! Somebody once told them that was a healthy thing to do.

Then let's deny medical care to Olympians, airline pilots, circus performers, veteranarians, police, fire fighters, window washers, electricians, construction workers, allpromiscous people, gay or straight who might contract HIV or other STD's,...and a gazillion others whose "lifestyle" can be life threatening? This is ridiculous.. What next, soilent green factories?

So easy to say deny smokers and the obese...what about denying iv drug users, those who have contracted sexually transmitted disease because the entertain multiple partners, those who are homosexual and have contracted HIV or Aids...what if they decide to deny insulin to those who have created a circumstance for diabetes...what if they deny care for a battered spouse because they chose that relationship...so where does it end and more importantly...WHO decides.

The British government imposes a tax on people for NHS care if they are imposing the cost on the working public shouldn't those who pay receive care without regard to their habits? After all isn't it their GBP that support the system...at a huge expense. Why should any be compelled to pay and not receive care for their ill....while these imposed taxes are being heaped on the earning public to support those not paying into the system. National health care is a joke if they can justify not providing care to those paying in.

I think everybody is missing the point on this article. First of all, doctors are not going to be witholding care to anyone. This was simply a survey that was put into a doctors lap (many times they are paid to fill these out) and has a leading question that they had to fill out. Think about that point for a minute. If everyone on newsvine had to fill out the same question, the same damn result would come of it. Of course some doctors are going to fill in the yes oval because it reflects their personal views on people who don't take care of themselves, just like you and I feel. The only thing that should be taken away from this article is that there is a need for personal accountability on the part of the individual to reduce the total health care burden. This result also reflects a doctors frustration with trying to treat patients who are killing themselves.

The effects of these unhealthy "lifestyles" aren't "supposed" they are proven scientific fact. With freedom comes the need for responsibility. Why should the rest of society go broke (and provide suboptimal care to those who try to lead healthy lives and follow the advice of their doctors) paying for the results of the irresponsible behavior of the people who just want to do whatever they please? The "Rules of the Common" should hold. A system where individuals can tear up The Common because they feel like it and the rest of society pays just doesn't work. If you want to abuse yourself, act irresponsibly, etc. then don't take part in The Common. Hippocrates also had a moral teaching about acting responsibly. And drushalli we aren't talking about accidents or the side effects from people trying to lead responsible lives.

Aggie-345886

Soylent Green factories happened because of how we lived, polluted and overpopulated the earth. I just applied for new health insurance, and the insurance company won't insure for the things you wrote.

There is something to be said for being personally responsible, and not holding others accountable for your actions. Making others pay for your mistakes is doing just that.

What about a;; those people using tanning booths or tanning at the beach...seems to be a lot of evidence on how bad that is for you now...or sports stars...they seem to get more than their fair share of injuries,how about sky divers or mountain climbers...that don't seem very safe to me...and lets not even get started on the military...heck...they are just asking to get shot...maybe we should even toss in anyone wearing a hoodie as that seems to be dangerous these days. The list could go on for what someone deems dangerous and self inflicted harm to yourself and thus not be covered. Now I can see why everyone says Gov. run healthcare would be so cheap...they won't have to treat anyone.

But I am guessing all those denied service will still be expected to pay taxes to help cover the cost for others I bet.

Really cluttered here with people pointing to ridiculous extremes to make their point. The obvious (or at least it SHOULD be obvious to the ranters) that they are talking about just what they gave for examples. Why give a healthy liver to someone who refuses to stop drinking (I've known some who continued to drink themselves right into the grave) and will just destroy that liver too? And because that alcoholic got that liver, the person mentioned above who had Hep C died before s/he could get one. What a waste! The smoker who won't stop smoking gets a heart or a lung? Lifestyle choices here means that which WE have control over, we can stop drinking, smoking,gorging ourselves with food, and especially drugs. Someone above mentioned that if they really wanted to stop people from smoking, they would ban cigarettes. In case you haven't noticed, they tried that with alcohol, and drugs are ALREADY illegal, and neither solved the problem. WE have to decide to stop or never start at all. It never ceases to amaze me that there are people stupid enough, after just casually looking around at how druggies, smokers and 500 pounders end up, who still use drugs, cigarettes and don't take care of their bodies weight-wise. Yes, I smoked years ago, and yes, it was made glamorous to do so and the cigarette companies lied by witholding info that they had. But I can't believe how stupid I was to not realize that my lungs were never designed to breathe smoke (duh!), and that yes, it WOULD happen to me because, no matter how much I believed otherwise, I was NOT superman.

They are NOT talking about witholding treatment from HIV or STD patients! You can get HIV from a blood transfusion or heterosexual sex. You don't HAVE to be promiscuous to get an STD. You don't have to run a marathon or play extreme sports to sprain an ankle, pull a muscle or tear a ligament. Any of those could happen in any number of accidents. But destroying your lungs with smoke, your liver with booze, and just about everything in your body with excessive eating or drugs, and then ON TOP OF THAT, refusing to change what you're doing so that the help you get will work, THAT'S what they're talking about, people. Stop trying to BS the story with conspiracy theories!

witchrunner and BEz1, it looks like you get it. According to need; oh boy, there's a line straight out of Atlas Shrugged. Hypcritical Oath sounds apt.

Just about all the over 80's whom I know have either had coronary bypass or they need it. And only about 25% of them ever smoked. I can understand trying to get an obese person to lose weight before hip or knee replacement, but to deny outright? Hmm, perhaps withold the steroids that they must take for medical reasons. A smoker with rheumatoid denied care? There's a whole lot to consider here that's below the surface.

Remember the huge multi-billion cigarette settlement for each state? That all went into general funds and all the states had to do was run a few anti-smoking ads.

People need to think about the consequences of public health care in the US. Know anyone in Canada or the UK? How would you like to wait 6-8 weeks for an MRI and get dumped out of the hospital in extreme pain but the docs can't treat you without certain procedures first.

sarita: Spoken like a true lib. And yes, there are college students who don't apply themselves, which was the essence of my comment regarding sitting around and partying. If you've been to college and haven't seen that then you haven't looked very hard. I'm sure if you apply yourself you can understand the point I was trying to make. If you believe that generalizations can't be made just because they don't include absolutely everyone, then it's impossible to have a conversation with you. But, we know that's not the case because your post included a generalization, even if it has no basis in facts. Just go to the projects where people are given their housing on the taxpayer dime and go to a neighborhood where people paid for their own houses. Do they really look like they are kept up the same?

Regarding colleges you said "The colleges and universities are increasing their own costs at a rate that far exceeds what is actually necessary for their maintenance." Not sure what your point is there since I can't figure out what you are trying to say. Their costs are their costs. Are you saying that they are incurring more costs than they need to? Or, are you saying that they are charging higher fees for tuition than they need to? Obviously, these are two different things. If you think your statement was clear then I suggest you go back to your college and sue them for failing to educate you.

Do you know why colleges costs as much as they do? It's simple really. The money thrown into the education system creates a major distortion of the economic system. Colleges spends lots of time and money raising money and making sure as many students get aide as possible. Why? So the administrators and faculty can continue to get paid the kind of money they are making. Without all the extra money, including a lot of taxpayer dollars flowing in, they would have the funds to live in the lifestyle to which they have become accustomed. And how many students have you known who have gone to college yet didn't know what they wanted to do? Plenty! And 99% of them don't have to foot the bill. Either grants, loans, or Mommy and Daddy foot the bill.

I believe that GetReal summed it up nicely.

I don't know many doctors socially, but of the few I have known personally, one was abusing valium and was an alcoholic, and the other was on some kind of stimulant that had the effect of cocaine. That's only two doctors, but since I've only known three, it makes me suspect that doctors may be among the biggest group of prescription drug abusers in the nation. Should they therefore be denied medical care?

Furthermore, they work too many hours and often eat hospital cafeteria food, which is unhealthy by any standard. Studies show their lifestyles increase their risk of heart attack due to arteriosclerosis. Consequently, by their own standards, they should not receive coronary bypass surgery.

Furthermore, the sweetheart who performed my endarterectomy wasn't obese, but was certainly pudgy.

...

Now, let's take a hard look at this. Since two thirds 2/3 of the population is obese and half of the skinny people smoke who would be left to insure????? Most likely it would be active children under the age of 8 years old.

Wow, what a great way of government control of NATURAL SELECTION. Just think, in 40 to 60 years a country the size of England could become a "mean.....lean.....fighting machine, again.

...?

If they don't like what they are looking at they can shut their f--king eyes

Well it sure didn't take long for people to skip reading the actual article and go straight into screeching hysterics about life or death.

Life or death, isn't that what the whole profession is about instead of the god complex. Ok these days it is all about green paper & power. How ever America take a good deep look at socialize health care because this is the furture the Democrate party unless you are a minority that gets everything they want for free from tax payers everytime they cry discrimination.

@ DKJ - Aren't conservatives always telling people they need to take responsibility for their own actions instead of expecting other people to pay for it? That's precisely what doctors in the UK are doing.

My car insurance skyrockets when I get a speeding ticket or they may even drop me if I get in an accident. My car insurance rates depend on my actions and I have to pay increased rates when I'm irresponsible.

Health care insurance doesn't hold people responsible for their actions (like getting morbidly obese, failing to exercise or smoking) and coverage depends on how lucky you are to have an employer with a good health plan. I can see where these doctors are coming from, we have to start expecting people to take personal responsibility for their irresponsibility. Of course doctors take the Hippocratic Oath and this is not something doctors should determine - that's what politics is for.

I'm fat and I smoke. It seems to me that with certain treatments that are very limited in the resources available to use on patients, I can see that it does makes sense to use certain lifestyles as part of the criteria for choosing patients. If I have one kidney to place and 2 people can use it and both need it, why not choose the one that has a better chance at fewer complications? But what that means to me is that if one of the patients is fat and smokes and the other is not, maybe you give it to the one that isn't fat or smoking. On the other hand if one is fat and smokes and the other has a lower chance of surviving surgery, then give it to the one that is fat and smokes.

Lifestyle should in no way be used as criteria for treating anyone for a condition where treatment is available to anyone else. At least where the fact that they smoke or are overweight don't push the odds of success to almost zero. (I remember reading about a case where surgeons refused to reattach some severed fingers because the patient was a smoker and they felt that by smoking the chances of the fingers taking was virtually zero. In this case the theory was borne out when one surgeon relented and preformed the surgery only to see the fingers die from blood constriction after the patient sneaked a cigarette.)

Haven't our cousins across the pond been doing the locksteps with the USA thing for the longest time now to even where they seem to have taken up the T'repcondino stance on their economy to their detriment, as they are now watching their economy falling into a double dip recession. Now they are lockstepping with the USA on healthcare issues too? Haven't they done that already with their underfunding of their NHS?

Are their private for profit insurance companies and hospitals over there pushing for privatization of the NHS like the T'repcons are trying to do with Medicare in the USA?

Don't they already know that you do not save monies by denying access to healthcare from a primary care physician/ GP? That sort of denial of healthcare at the primary care level is common in the USA no wonder the cost of healthcare is so high here because folks who do not have private health insurance coverage go to the ER for care here, or do without or go into debt to pay the medical bills losing everything from savings to their home, while in the UK the patient goes to their GP thus the cost is lower and the outcome better as there is followup care. In the USA uninsured patients who goes to the ER for treatment do not receive followup care as there is oftentimes no where to go for same.

Folks without excellent private healthcare insurance or Medicare or Medicaid in the USA are being admitted to the hospital sicker and therefore it cost more money to treat them in the Intensive care units etc. as they oftentimes wait to seek treatment because of lack of funds. The way things were or will be if the new healthcare acts is recinded, folks who have or had a preexisting condition could not/will not get insurance coverage or if they could or can they perhaps will not or cannot afford the premiums for any length of time as these premiums are extreemly costly.

HIV/AIDS is on the rise in the USA of all places, because of lack of access to affordable care/checkups etc and the cost of treatment is very expensive. How many insurance companies pay for this sort of treatment? These patients either get treatment through charity clinics if they are lucky or through Medicaid if they are eligible if they cannot get or did not have private for profit Health Insurance in the first place. How about dialysis etc? Will the private for profit insurance companies pay for ongoing dialysis after the person reaches their catastrophic max or are they then left on their own? How about cancer treatment or that child with Hodgkins, Lukemia etc? How long before the for profit ins co stop paying because the child has reached the catastrophic cap, thus denying care? Medicaid may pay for these treatments if the person qualifies, and the same goes for those folks with Alsheimers or dementia. This is the very same Medicaid that the T'repcondinos want to defund or are defunding and or want to privatize. LOL

Another thing is that there are more and more Americans doing the medical tourism thing these days, seeking care in other countries like in South America or in India because it is more cost effective than in the USA when the patient do not have health insurance or would not be able to pay for the enormous built in out of pocket cost for surgery etc.

Perhaps the Docs in UK are looking across the pond thinking that doctors in the USA are making more money than they do and that they are earning less because of the cost of caring for the obese or smokers who are supposedly sucking up the extra funding in the system that they could be getting if their national healthcare system wasn't paying for the obese and the smokers, not taking into consideration that it is probably because their govt is/have been underfunding their NHS. LOL

Perhaps the docs in the UK now want to have the burden of or carry those enormously expensive malpractice insurance that doctors, nurses etc must have/carry in the USA? That should increase their overhead cost quite nicely. lol

Don't docs over there have a patient base already built in when they open their office and do not have to be dependent on some contract or other with private for profit health insurance companies to be a participating doc in that private health insurace companies network, where the subscribers/members of that plan can still chose to go to which ever doctor they care to in that network/hmo in the USA?, In the GB/UK don't patients register with a doc in their area/village/close to home etc?

Are they dependent on their patients paying them when they visit the office or aren't they paid whether the patient visits the office or not providing the patient is registered to that doctor? In the USA patients may not be insured and/or do not visit the primary care doctor so he can get paid by the private for profit insurance co or by the patient, so.....

So who is better off ? Docs in the GB/UK or Docs in the USA? One could say the docs in the GB/UK are better off because they are getting paid by the NHS and they can also see patients covered by private insurance and private pay patients also. LOL Well at least that was the way it was in the past if I remember correctly.

Oh well let those docs over there be like the docs here...i.e. be dependent on the private for profit health insurance/hmo companies for payment and having to file a gazillion claims to the various insurance companies and wait for payment or get denied payment and then have to go bill the patient for the monies.. or watch their practice dwingle with/like their patients or former patients resources. LOL

Perhaps the docs in the UK would like their income being dependent on the whims of the insurance companies re what they will re-emburse for care given, or not knowing their patients or the patient pool in their area going outside of their neighborhood to some doctor several miles away or even the doc the next block down the street just because. LOL

Docs in the USA accept Medicare because the payment for their services are guaranteed by the Medicare Insurance program whose payment and guidelines are set up by the USA Federal govt and administered by a private insurance company who have the Medicare contract. It was stated that if it was not for Medicare, docs in the USA would not have the earnings that they do enjoy now, if I am not mistaken.

So docs over there now want to start competing for patient and patient dollars too huh? LOL Want to pay all that money for that malpractice insurance too and have to be worried about the possibility of being sued huh? Oh well be careful what you wish for.... LOL

Perhaps it is time that obese patients and those who smoke etc start suing these doctors for discrimination and denial of care... nothing like getting a dose of their own medicine. See how long they will be able to remain svelte and be able to take those yearly vacations etc or retire to the South of France etc. They too will be fat or obese from all that cortisone that the body produces or over eat due to stress and will no doubt chain smoke and drink like a fish due to worrying about what tomorrow brings like the rest of us poor s.ods. LOL

Hope all those doctors are slender enough and have a pristine lifestyle because they too would be denied care due to their obesity, smoking and other supposedly distructive lifestyle choices, and have to seek care at some ER or other too. Hope they get seen by a very judgemental lifestyler ER doc too.... LOL

Peace.....

GetReal....It isn't just an article...it is reality in the NHS...the physicians do withhold care...they do neglect their patients. In lieu of proper care they do just prescribe maintenance drugs in the place of true care. As US citizens living in England we were charged a great deal for NHS coverage. The NHS failed us....when we were repatriated to the US the throat issue my husband had been seeing remedy for was diagnosed as thyroid cancer....the NHS physician never once over several visits bothered to palpitate my darlings throat where he should have been able to feel the nodule. My back pain was diagnosed as depression and treated with anti-depressants, muscle relaxers and pain killers upon return an MRI of my spine detected bulging disks pressing on nerves. So yes the NHS currently rations care and it would be lovely to know what criteria they use to withhold reasonable and prudent care.

Fortunately, in the US care is provided regardless of who the patient is or what they pay for insurance and care. Our system is far from perfect but it does attend to the needs of the community.

John: Right! So to control "over population" let's just get rid of a good chunk of people. "Select" them to become Soilent Green. Let's throw in anyone who drives a car, runs farm machinery, heat our homes. Let's shut down all airlines, ships, trains, trucks...pollution.. And let's make insurers build in "confessionals" and mandate everyone to share/confess their most intimate and personal actions.....Cook 'em all!

"The occupations I listed are ABSOLUTELY covered by insurance. You might want to look for another insurer. I know people is just about every field I mentioned and every single one of them is covered by insurance.

Not sure what to think of this, honestly. To be sure, smokers and the obese are a disproportionate drain on a public health system, since they consume more services in relation to other citizens who contribute just as much...

Not true. Studies simply haven't been conducted to determine just how much other activities or addictions contribute to declining health.

I work for the largest benefits administration organization in the world, and what we find is that, generally speaking, all addictions are equal. You can be sinfully skinny but still have arteries so clogged that you're a walking heart attack thanks to those Doritos or other "simple" pleasures that you allow yourself. Your can appear perfectly healthy, but your obsession with Mountain Dew and other soft drinks can be rushing you closer to your demise just as quickly as a cigarette habit can. You can live life without a single drink, but those who drink in moderation are more likely to have a healthier liver than anyone else.

That's not to mention that over-eating is not always the cause of obesity.

You, like many people in this world, may think you're doing better than those who use alcohol, tobacco, or an over-abundance of food, but I can guarantee you this...you have an unhealthy habit that is just as likely to put you six feet under.

TXMOM... back in the day foreigners visiting/working in the UK did not used to be charged for healthcare if they got ill there and needed hospitalization or ER care. But then there were many people who started to take 'medical' vacations or one could call it the precurser to the medical tourism happening these days. Unfortunately with medical tourism the patient pays for their care, while unfortunately those who supposedly 'suddenly got sick' while on vacation was becoming too costly to the NHS system so these folks started to have to carry insurance or pay in cash for their care.

The same thing used to happen here in the USA where folks would suddenly get sick and were having all sorts of very expensive surgeries done on them especially as it pertains to cardiac surgery. Many got emergency Medicaid coverage too.... until now that is no longer happening/allowed, as visitors must have health insurance coverage and if the person is sponsored to stay in the USA the person who sponsors that person must also sign doccuments that they will be responsible for the person/visitor/immigrants healthcare costs too.

If you believe that you would get better care in the USA it is doubtful, as doctors do the same thing that was done to you there. No matter what you cannot legislate caring. Even with primo private health insurance you can receive lousy care in the USA too. Been there experienced that myself, difference was that I was told by the neuro guys that I just did not want to work..... or if it gets worse come back... which led to years of suffering and not knowing what the problem was, now finally dxd and nothing can be done... Back then one also had to get a referral etc. so trying to get a second opinion or some testing not done in the docs office was nearly impossible and whose testing amazingly showed up no problems. Finally was able to find a doc who knew his stuff and cared enough to go the extra mile. Could go on but why bother.

Over the years healthcare delivery has changed, there and here from the look of things. It is all about the money now. Insurance Cos do decide what care you get and for how long too, unless someone in the ins co or at the hospital/doctor's end goes to bat for the policyholder/patient and shows medical necessity otherwise the policyholder/patient is on his or her own to fight the battle for themselves while going through ill health/suffering/worry/fear/income loss etc which is not the ideal situation for a positive outcome. These days you have to be your own advocate no matter where you are whether over there or here. Nothing like underfunding a system to cause problems. Plus not all docs are equal in skills and knowledge base.

How is it possible for young athletes to drop dead after participating in their sport activity? Why? But it happened here several months ago. Didn't they get a full and complete physical etc and cleared to participate in such physical sports activity? Oh well....

Perhaps if one is a celeb or a member of congress or is rich or a lawyer then the treatment is different. Meanwhile medical tourisim increases... as more and more patients go to places like India and certain countries in South America for their medical treatment/surgery because they get stellar care but pay less for it.

Lock stepping lock stepping and culling..... that is the way it is these days. Capitalism rocks for some... while for others here that are uninsured or have a pre-existing condition, they must seek care/help from charitable sources. LOL

Do patients in the UK have to seek their medical care/help from the ER or charities too, because they do not have, cannot afford private health insurance coverage? Doubt it.

Peace.....

Peace.....

Yes, but where do you draw the line between a person's lifestyle and medical situations? For example, should health and family service organizations go in to people's homes and see if the person is a hoarder, as that would be a very bad environment to allow a baby to grow up in, and then deny them the right to IVF if they are? Why would you allow a hoarder to have children, and not a smoker?

You would deny them IVF because smoking reduces the effectiveness of treatments and often increases the risks associated with various procedures. Hoarding does not normally do that.

This policy if enacted would mean that the state will be executing people without committing a capital offense. With holding by pass surgery to a patient who has had a heart attack is tantamount to first degree murder.

This just goes to show the world how the west has degenerated into depravity with no sense of empathy, ethics, morals or sense of compassion. The first principle of a doctors oath is "do no harm". Western civilisation is ceasing to be civilized and will crumble into the pages of history. Do you beleive that a smoking billionaire will go without their surgery? This and all the policies of the west are a war on the working class.

Continuous wars and economic crisis after crisis will finish off what's left of these murdering thieves and bandits of Britain and the United States.

If you read the whole article the physicians were specific in withholding treatment for in-vitro fertilization or a liver transplant. Why should tax payer dollars be used help someone get pregnant who is going to potentially harm that baby while it is in the womb? Why should tax money dollars be used to provide a new liver to someone who at the same time is poisoning their bodies, putting themselves at risk for multiple cancers & a lower life span over that of a non-smoker on the liver transplant list? This is what drives the conservatives mad & I am a liberal who voted for Obama. Enough is enough.

Well, how about the case of Mickey Mantle? He essentially killed his liver with alcohol, but had no trouble obtaining a transplant. So, if you are rich enough or famous enough, you can get whatever medical treatment you need. But if someone is obese (whatever that means these days!) or smokes, then they should be denied? That seems really harsh! Anyone who has quit smoking can tell you how terribly hard that is. In fact, many doctors are closet smokers. And as for obesity, who decides who is obese and who is not? We all think we know--it's "that fat person over there." Many people who don't think of themselves as obese really are.

I'm a smoker and I agree with them. I just don't see why someone would smoke while going through IVF treatments. I think that I should also be denied a heart transplant if I ever needed it, unless I can prove that I had quit smoking for over 10 years or something. Something to show that I would be serious about taking care of the new organ. I wish there was also a cut off age. The young should have a chance to live and the elderly should only receive a new organ if it doesn't match the younger people.

This is just another example of ethics being debased by bottom-line thinking.

To the folks who cry, "Why should my tax dollars go to...(fill in the blank)"... you would be better off to worry more about wasting your taxes on trillion dollar items like Iraq or to any of the militaristic efforts that actively kill people around the world by the hundreds of thousands than about the relatively minor costs of organ transplants that might go awry because of some individuals personal addictions.

But aside from those particular points, the entire idea of measuring quality of life or the ethical basis a society purely by economic criteria is pathetic and even sociopathic.

I am a bit appalled by what they are saying. The term obese is used when people are at least 40lb over weight. That covers a lot of people. Most people do not want to be overweight. Why don’t we ban cigarettes, any type of food that makes you fat, ban alcohol, and while we are at it ban anything that causes humans direct harm. Let us be perfect! Doctors do smoke, drink, and I have even seen them overweight. Shall we deny them medical treatment too…..Most people pay for medical treatment in some form or another. Oh and why don’t we not allow people the privilege of health care if they are unemployed.
Wow I don’t really like where this is going. I do understand that you do not want to give organs to people who abuse alcohol, or smoke as they could be given to people that do not have habits that destroy their bodies. They should be considered first! We could also just put the elderly to sleep after they get to a certain age, then we don’t need to provide them with medical treatment either. What I am saying is there will always be a reason to deny someone health care. Even if alcohol and cigarettes are banned and we are not allowed to eat cream cakes etc., next it will be dangerous activities such as skiing or horseback riding. I forgot to mention sexually transmitted diseases. Let’s not indulge in sexual activities for fear that if we get a STD they may not allow us medical attention.

Doctors and patients who oppose lifestyle rationing call the approach blackmail that denies the sick their human rights, The Observer said.

YOU DON'T HAVE THE HUMAN RIGHT TO BE obese OR smoke. ALCOHOLICS SHOULD NOT GET A NEW LIVER EVEN IF THEY STOP DRINKING. IT'S THEIR FAULT THE LIVER GOT DAMAGED IN THE FIRST PLACE.

Jake $$, what gives YOU the right to say who doesn't get human rights and who does.
Please, see a shrink because you have some SERIOUS issues!

Jake,

Sorrry, but I think you are dead wrong. And you can't possibly be perfect in all your habits. I sure hope you are never denied any care because someone doesn't feel you deserve it for whatever reason.

Did many here actually READ this article? The story I read said this was in UK, NOT USA.

My understanding of the UK system of NHS (National Health Service) is that they have automatic health care- sort of like our (USA) "welfare" medical. From the individuals I chat with in the UK over the internet, it's a real lottery as to whether that medical care is excellent to extremely sub-par, again- just like our welfare medical. The commonality is that neither their NHS care nor our welfare medical (medicaid) are paid for out of their own pockets. OTHER people pay for that care for everybody that uses it.

My other point is that this article clearly stated NON-EMERGENCY care. How did organ transplants come into it? I would think that by the time someone NEEDS an organ, the situation is pretty darned EMERGENT!! GIVING an organ is elective, receiving an organ is not.

Lets remember please while the political trolls are complaining about Cheney's heart and Obama's death panels, that this article is about NON-EMERGENCY care in THE UK.

A doctor must assess the probability of successful outcome. Will the medical treatment actually provide the desired outcome?

Like it or not - the article is NOT about lifestyle choices - or - about denying medical care. The article is about relying on a doctor's professional judgement to determine if providing medical care will provide a desired outcome.

KM-1447354

Yes, we did read the article and are having a discussion and imagining if it were HERE.

This policy if enacted would mean that the state will be executing people without committing a capital offense. With holding by pass surgery to a patient who has had a heart attack is tantamount to first degree murder.

It's already happening. Read up what Governor Jan Brewer of Arizona is doing to over a 100 transplant patients. Source: http://www.cbsnews.com/8301-504763_162-20023102-10391704.html

You can find lots of articles about it. This policy has already been enacted. It just so happens that it is being done by opponents of Obamacare, and here in the US.

Byron Raum,

And you also need to broaden your argument to insurance companies either refusing to approve treatments, or delaying their approval until the issue is moot with a patient dead or dying.

And yes, this does happen. Just like hospitals refusing ER treatment until past dues are paid, or out-of-state insurance can be verified. And pharmacists asserting their moral judgement OVER the LEGAL requests (demands) of their customers. As if percoset or oxycodone (popular abuse drugs) are more moral than birth control pills.

Jake, Jayell and a few who want to pass jugments withut knowing facts: Obesity is often a result of a glandular, endocrine, thyroid problem, inherited body type (and often emotional or mental health issues). A doctor has no way of knowing -- unless he's the sort that just passes judgment on looking at the patient. He must first treat, agree to see, and run a few tests before passing judgment. Often, people with weight problems can be treated with medications -- just as those with diabetes and high blood pressure (often inherited) can be treated and their symptoms managed.

BTW, don't rag on me, because I'm thin with low blood pressure and no diabetes, no STDs, HIV, and never been pregnant. So far so good, but knock on wood, I don't think I'v any inherited maladies. Nonetheless, I have great compassion and empathy for those in need of medical treatment to manage their illnesses and medical issues.

This just goes to show the world how the west has degenerated into depravity with no sense of empathy, ethics, morals or sense of compassion. The first principle of a doctors oath is "do no harm". Western civilisation is ceasing to be civilized and will crumble into the pages of history. Do you beleive that a smoking billionaire will go without their surgery? This and all the policies of the west are a war on the working class.

I'll tell you what is depraved, immoral, unethical and without compassion is our current health care system that Republicans insist so fervently on keeping. What we need is a single-payer system (like Obama wanted but instead Republicans forced to go with individual mandates) like the rest of the civilized world. What you are objecting to so forcefully already happens in the United States every day to poor people that have NO insurance. So, you may think morbidly obese people not getting medical services is terrible (and I basically agree) but it is even worse that so many poor kids and families go almost completely without.

Don't worry about doctors, they treat every patient assigned to them. It is the political system that we have to be very concerned about because that is how we pay to provide people with health care.

There are other ways to give incentive to people to lose the fat and stop smoking - raise their insurance rates and make them pay for their irresponsibility. I hope no one is suggesting to let fat smokers die....

What a bad potential trend this is. Denying a woman IVF treatment because she is obese is ridiculous simply because many of the fertility treatment medications pack on the pounds like crazy. So, the dr gives a patient meds to try first, then after she swells up from them denies more advanced treatment because she's now obese?

I've seen many arguing against liver transplants for abusers, but again, no one thinks it through. My former babysitter's mom died after being denied a liver transplant here in the US. She had had abuse issues in her past (15-20 years prior) due to depression. She had been clean for over a decade, but with things failing was in a great deal of pain. The previous addiction prevented doctors from prescribing pain medications, so she took Tylenol. Since Tylenol can cause liver damage, that was the basis for her denial of a transplant. It's just not always clear cut and dried.

If the establishment decides it's ok to withold services for those who have lifestyle choices they disagree with, what comes next? After my daughter had a severe reaction to vaccinations she no longer gets them - will she then not be treated for a condition that there is a vax for? We try to use natural remedies when we can, yet many doctors scoff at that. Will that be used as basis for denying treatment? This has great potential to be very ugly.

You would deny them IVF because smoking reduces the effectiveness of treatments and often increases the risks associated with various procedures. Hoarding does not normally do that.

You're 500% absolutely wrong here. The short, and long term effects of hoarding have a terrible effect on the body's reproductive system. Not only do you suffer from unhealthy air that is unavoidable in a home that cannot circulate air correctly, but it is impossible without the presence of a professional cleaning team to prevent insects, rodents, viruses, and microbial infections from occurring as a result of the decomposing food and other wastes that are present in every hoarding scenario. Each of these things contribute to a lowered immune response, which makes fertilization more and more unlikely, and in-womb survival rates sequentially lower.

Hoarding is one of the highest amongst many issues that can cause deadly illness. Many thousands of people die every year from environmental factors, often attributed to hoarding or general uncleanliness.

The claim that most people have something wrong that made them obese is unfortunately wrong. Endocrine and thyroid issues are not common, it is a misconception that many people who have high body mass index and high levels of body fat claim. A very small percentage, perhaps between 2 and 5% have a true medical reason. The rest is a combination of lifestyle habits.

I personally would deny IVF to women who are very obese, are smokers, alcoholics, or several other conditions unless they stopped beforehand simply because these disorders cause very high risk of LIFELONG problems for the baby. Do you have the right to inflict harm on an unborn child?

I have a sometimes-genetically-linked mild congenital heart defect. Someday, should I be married and chose to have children, I may be faced with some difficult decisions. I love children, and very much want to have children someday, but should the risks be high, I'm not about to put an unborn child at risk. Yes, the chances of local adoption of a newborn or young baby are small, but there are still other options. In every other aspect besides my heart valve, I am considered the 'picture of health' at 21, I exercise, I am vegetarian, I maintain an appropriate BMI and body fat percentage, my cholesterol levels are perfect, blood sugar is great, thyroid is fine. I am just 15 credit hours away from graduating with my bachelor's degree...

Perhaps all of this has given me the clear picture that it is not my right to hurt a possible future child. My severe near-sightedness is one thing, but if the risk of my heart having complications during a pregnancy are deemed too high...it's not just my health at risk but possibly the life-long health of an innocent person.

The claim that most people have something wrong that made them obese is unfortunately wrong

Where the hell did you get that from? Just in the United States, thyroid issues are widespread and on the ride. Ever since the government programs were created to iodize salt and other foods, thyroid disorders such as hyperthyroidism have become critically wide spread, and are only accellerating.

Many studies have proven a link between the chemically enhanced food supply of the last 50 years, and a myriad of disorders, many of which influence weight gain and nervous system disorders.

You should not pass judgment on others, especially with information that was either made up, or is deeply flawed.

My understanding that proof that alcoholism is in long term remission is part of the screening process for a liver transplant in the U.S. already particularly -- if that is why the liver is failing in the first place. When there is such a long waiting list why put in another to be destroyed? Alcoholism is a terrible disease, and there does appear to have a link to genetics, although like obesity nature versus learned behavior is not a clear distinction, yet knowing that you have the propensity to be easily addicted is at work in foresight and prevention, not a carte blanche to get your liver replaced.

Stand, If you have a family history of Alcoholism, and you start drinking,,then I have Absolutely NO sympathy for you at all. Lifestyle is about personal Choices, and personal responsibilies for those choices. I see no reason why I should have to pay for your choices.

If you are a long time drinker with no intention/desire to Help yourself, should healthcare pay good money for a transplant to keep you alive longer? Hell No. Give it to someone who will make good use of it..

Well said Janine. We have to draw the line somewhere in terms of the costs we all bear due to the lack of accountability people have for the choices they make. America is a nation of selfish whiners who refuse to accept the long-term consequences of their actions. Some tough love is definitely in order.

I am more than OK with paying into the system to help people who have unforeseen health issues. But I am NOT OK with paying in to help those who refuse to help themselves.

....

Things are just looking better and better all the time now in the healthcare industry worldwide.

Just take a close look at the general population of the English people. At least 66 % are obese by the standards of health 30 years ago....and half of the other one third SMOKES....the skinny people.

What a great way to cut healthcare cost if you can eliminate the obese and the smokers from being insured in one shape or another.

What a great way of all governmental controls of NATURAL SELECTION ! ! ! ! ! !

I see way more people who are overweight smoking than people who are of a normal weight...just saying. I am what would be termed thin and I certainly do not smoke. Nor do the vast majority of my fellow normal-weight friends and family...

Quite right. Everyone is crying "Obamacare!" but there IS no Obamacare! It doesn't EXIST! What has happened, though, is that insurance companies, hospitals, pharmaceutical companies and manufacturers of medical goods jacked up their prices "in anticipation" of changes that are apparently never going to take place--not with everyone whining in misplaced fear about "death panels" and government control.

How much more of a blatant example of corporate greed do we need to witness in this country before we WAKE THE HELL UP?!? The very THREAT of change made everyone raise prices to squeeze whatever amount of money out of the American people that they could... and yet where does the blame go? On the President, for wanting to "rock the boat" and (gasp!) change this broken system!

Sadly, many people get rich off the system as its currently set up. For-profit health care will never disappear in America. Just like any other service, if you can afford to pay for it, great. If you can't, you just do without....or have the sucker taxpayers pay for you.

What's wrong with for-profit health care? Everything else is for profit.

@Craig - there are plenty of not-for-profit hospital systems in the USA. I'm having a hard time seeing a UK-style system with rationing as being better than a system wherein we're simply required to have some coin in order to pay for treatment. Rationing treatment because of lifestyle choices seems to me to be an infringement on individual liberty.

But perhaps you're not interested in individual liberty....

Jim,

There will always be some form of rationing. If the taxpayers are paying for health care, there is a limit to what can be covered. It's not an unlimited pot of money which is why the UK system includes certain limits and quality of life considerations. Most Britons are ok with that. With a taxpayer funded system, they can either give unlimited treatments to some people and then deny everyone else when the money has run out or give everyone basic health care and deny some individuals certain treatments/medications when the cost outweighs the benefits. It may seem cold but it's the only way that type of system works. There has to be a limit somewhere to keep the system from going bankrupt.

If an individual/insurance plan is paying for health care, it's the same thing. There is a limit to what the individual can afford to pay or what the insurance policy was written to cover. The not-for-profit hospitals in the US still have to be paid by someone.

You have the individual liberty to lead the type of life you want. But individual liberty does not extend to requiring others to pay your medical bills due to unhealthy lifestyle choices.

What's wrong with our for-profit system?

It's unnecessarily expensive. We're the most expensive system in the world but only #38 in results. We spend 1/5 of our entire GDP on health to support insurance companies that contribute nothing to health care but 20% annual inflation in premiums, 40% of every premium dollar in "admin costs" which include a $54million salary to one of their CEOs last year-M'Care does the same for 5% - and delay (for the "float" income), denial and pre-existing exclusions (to "cherry pick" only the healthy). We also support for-profit providers and Pharma, who create the $3,000 MRI, the $1000/night hospital bed, the $250 10-minute office visit, the $1500 ER visit for a few stitches and the $10 aspirin. Regardless of who pays the premium (you or your employer) everyone overpays. Why do 18 of the G-20 developed countries have non-profit single payer? How do the Japanese pay $400/ year per person for 80% payment of all costs? Can you do that? We already have non-profit single payer in Medicare and Tricare. In Medicare we pay $100/month to cover 80% of all costs and can purchase "Medigap" coverage for $200/ month to cover the remaining 20% of all costs plus cover the deductible and co-pays. That's $300/ month to never get a bill for anything, to be covered for everything and to never confront collectors or personal bankruptcy (the majority of which are due to medical bills). Non-profit single payer (aka: Universal Care or "Medicare for All") eliminates private insurers and for-profit providers, lowers costs (by half or more) and improves results (by covering the 15% of us- 45 million- without non-emergent care under the current for-profit system.

The original "Obamacare" included a "public option" which was non-profit single payer and existed ONLY as an option (to for-profit care via insurance vouchers). Knowing that virtually all Americans would have chosen the option (dramatically lower costs) and knowing that would effectively eliminate private insurers and for-profit providers/Pharma, the Republicans (the defemders of private insurers, for-profit provideres and Pharma) demanded its exclusion. They succeeded. They "settled" for a requirement that insurers raise their payout for actual health care from the current 60% (recall 40% is for "admin costs") to 80%, which has resulted in a $1B "rebate" from insurers to premium payers. Medicare's current payout is 95%.

Nothing is "free", including health care. Everything has "inflation", including health care. A non-profit single payer system would, by eliminating private insurers (who contribute nothing to actual "health care"), by replacing for-profit provider/ Pharma charges with a single nationwide price list for all medical goods and services, by replacing the current for profit inflation rate (20%) with the actual inflation rate (5% or less) and would allow us to improve results by covering the 45 million currently not covered.

"Rationing" exists in all systems. We ration based on ability to pay unnecessarily high costs and 15% of us become uncovered. The UKs non-profit single payer system rations to remain solvent- the only alternative would be to raise UK taxes to cover the shortfall, but the UK is in recession and cannot wisely raise taxes.

The ultimate debate is whether health care is a "right" or a "privilege based on one's ability to afford it". In either case, we can no longer afford, as a nation, for-profit health care which is bankrupting us unnecessarily and leaving 45 million of us without necessary non-emergent care. Non-profit single payer is inevitable and the sooner we adopt it the better for all of us.

craig,

I disagree.

You say we spend the most but are 38th in results. You are pointing a finger at our medical system as the direct cause of these results

You don't think our record obesity rates, lack of exercise, and other lifestyle choices are a bigger influence?

If I drive my car 90 mph, never change the oil, put in the worst octane gasoline, and crash it every other week, when it breaks down should I blame my mechanic? Or the auto industry?

Or myself?....thats actually the point of this article. Drs are frustrated with obese individuals and smokers because medical therapy is less effective in these individuals....

Eric,

You may certainly disagree if you wish. The facts speak for themselves. The system is the "direct cause of these" facts. The system has priced out 15% of us and cost the remaining 85% unnecessarily. There is an alternative system, tried elsewhere and successful, that would change both facts. Both systems must deal with the same "lifestyle choices".

what about the fact that our obesity rate is much higher than those other systems

What about the fact that we exercise far less than those countries

What about the fact that we punish our bodies in other ways (drugs, murder, etc)

It seems you only pay attention to the facts you like. Please address my car analogy above

Some of you need to do a little research. Due to the economic recession, a lot of insurance companies, hospitals and doctors have started to realize our current pay-for-service system is really not working. Because of both incentives "Obamacare" is hoping to implement and the current economic situation, they have started to make changes in the system to be more focused on efficiency in healthcare and not just on profits. It will take some time for many of these changes to be felt on a wider scale, but the change has already begun.

Soylent Green AND Idiocracy. Oh my God...the hair on my arm just stood up.

No Sh!t!!! What I would like to know is who are these people, what do they represent, what is their agenda? The bottom line is however money and power, and I guess that is a good place to start to get my answers. Here comes the new Holocaust!!!! See you all on the killing floor.

First Pink Slime, then Soylent Green. The idiocracy is already here.

What about all the zombies, ghouls & blood sucker all in the name of a few more months because they all fear death?

Zombies=walking dead

Ghouls= stealing body parts from the dead & partaking in the organs

Blood Suckers, whose blood do they partake in?

Let's deny health care to smokers who are unfairly taxed to pay for the health care of illegal children... because that's fair.

Everyone supports "sin" taxes - but only if you, yourself, don't participate in the particular sin. Need money for the SCHIPS program? Try taxing MILK. Now that is fair. Tax milk, juiceboxes and Lunchables.

at the rate the government is spending... we would all have to smoke 50 cartons of cigarettes...a hour to break even...

One of the chief reasons for the repeal of Prohibition was the realization that the Federal government had lost 15% of its revenue stream in lost legitimate alcohol production and taxation.

There isn't much to be done to help the obese other than telling them to move more and eat less, and they already know to do this, they just don't.

Elpea, you're right that that's what obese people get told. And if it were that easy, there would be no obese people. It's not that "they just don't." It's a lot more complicated than that. As it is, insurers make people pay a higher premium due to "build," which is just another way of saying that if you're heavy, you pay more. This seems right until you realize that insurance doesn't pay for weight loss programs.

Elpea,

You wrote: "There isn't much to be done to help the obese other than telling them to move more and eat less, and they already know to do this, they just don't."

Actually, there are practical alternatives. Lap-band surgery has proven to be more effective than any commercial or semi-commercial diet plan whether used in conjunction with a dedicated exercise plan or not. Further, simple diet modification only works for most people if it is applied in a controlled environment. When applied in the general environment, too many temptations, and even demands to eat and drink outside the diet exist. Social, occupational and even political events always seem to involve eating, and often drinking, as part of the process. And adequate exercise to modify weight can be not only time-consuming, but also painful to those with over-burdened or already damaged joints.

And you seem to ignore one large fact. Often the very disease that obesity complicates, can actually lead to obesity. Diseases like diabetes, consumptive heart failure, rhuematism, or even psoriasis. They can make exercise even more painful, cause exhaustion before adequate levels have been reached, or cause foot and leg problems, like diabetic ulcers.

Same thing can happen to anyone applying for health insurance. Just going by weight alone is stupid. I am overweight but my heartbeat is strong, I have low cholesterol, my blood pressure is perfect....

My brother was kicked out of the US Navy after 19 years & 8 months of service due to weight after returning from Operation Desert Storm. He was 40 years old & 4 months away from receiving his earned retirement benefits. I think in this case the US Navy simply went around kicking out everyone who was near retirement & was overweight so they didn't have to pay the monthly retirement checks to thousands of veterans. It seems from your post they did the same thing in the Air Force. I would bet this occurred sometime in the 90's.

Exactly! It is if you cannot meet the physical fitness requirements that they will really be concerned! Many of the men will be 'overweight' but certainly not unhealthy if they are keeping up with their physical fitness requirements. Women, less so, simply because we lack the testosterone required to grow muscles to that rate. It's still possible though, but having numerous friends in the Canadian forces or reserves, I do know this. I cannot join due to a congenital heart valve defect, but my friends have talked about it a lot.

Wow! You're one of those people who think the world consists only of what you can see from your living room window. People who exercise and don't smoke still get lung cancer, heart disease, diabetes. Vegans suffer the same diseases as everyone else. My guess is that the "healthy choices" you listed above describes your lifestyle. I'm here to tell you that regardless of how you live your body will still fail and you will die. How would you like for someone to deny you necessary medical care for a neurological condition because they believed it was a result from not properly washing the pesticides from your produce? Who gets to decide where to draw the line? And why stop at smoking and obesity?

K, while I agree with you that people who exercise, don't smoke, etc do get cancer and heart disease and the like the rest of your argument made absolutely no sense at all.

They are talking Lifestyle Choices, smoking, drinking, drug use, overeating etc. I agree with the view of the doctors for the most part, although I think there should be a review board if there is a question of coverage. One person should not be given the go ahead to deny.

You example about the neurological condition, while possible, is not conceivably provable. Unless there is a proved medical risk for your chosen activity, then it should be allowed

@ Thomas - Unbelievable. Are you going to have our government plan our meals, deliver the food and cook it for us too? How about sending a car by our house to take us to the gym? Do we low-jack everyone so we know they are taking care of themselves?

Maybe we should let them tell us which books to read, which shows to watch and what to think? Let's just ban the word "freedom" and get it over with. You sure don't know what it means.

I live in Canada and everyday I am thankful and deeply grateful for having medical coverage that I do not have to pay for. When my mom, who until she developed symptoms had been a very healthy, active, healthy eater, normal weight/normal body fat woman in her early fifties with a job that she loved and two daughters was diagnosed with cancer, everything was paid for. I can only imagine what hospital care, oncologist appointments, blood tests, a few blood transfusions, surgery, chemotherapy, more than one emergency room visit would have added up to.

Then there is my own story. I am 21, and until December figured that anything going on would just be due to the stress of carrying a full course load in fourth-year university. A visit to urgent care told me otherwise, and I can only think of what that one visit would have cost me...

-complete blood panel

-EKG

-Chest X-ray

-Doctor's consultation

-Urinalysis

...and then the referrals, as the doctor detected a heart murmur. Echocardiogram, stress test, more blood work, specialist appointments. I've been referred to genetics, can anyone guess how expensive a genetics consultation and testing would be?

Had things not been covered, I probably would have just gone home from the rehearsal where my heart suddenly went out of control and my hands and shoulders both lost sensation from fingers to shoulders...

Just because someone doesn't have a high-paying job doesn't mean that they don't serve a vital purpose to society...really, would we be able to survive without people doing things such as working in grocery stores, gas stations, plumbers, electricians, bus drivers? None of these people would be paid very much despite the fact that without them, our society would crumble.

As a 21-year-old, I would likely be just ageing out of my parent's insurance plan as I finished university and fully entered the workforce on my own. It's quite likely that I would be denied by many insurance providers because I was born with a biscuspid aortic valve that is now in mild regurgitation (aortic insufficiency, it means that a small amount of blood that should be pumped out of my heart through my aorta flows back where it shouldn't). There is a problem with that picture. Let's fast-forward down the road a few years...I would understand if I was denied coverage for IVF or something like that because of increased pregnancy risks, but to deny coverage at all...this is something I was BORN with, something that could not be prevented or even known about, given that I was born in 1990 when ultrasounds were not even routinely done on expectant mothers that often. A messed up heart valve certainly wouldn't have shown on a normal ultrasound either.

If I get sick, I have the reassurance that I can get it checked out. And most people don't abuse the system and go for every little sore throat, stubbed toe etc etc. My friend practically had to drag me to Urgent Care, even though my conductor was about ready to phone for an ambulance. Obviously, I'm closer to the other extreme, but most people do use the system appropriately. And to be honest, health care professionals would rather see someone who has a sore throat and tell them that it is nothing than to have someone ignore a sore throat and find out at autopsy that it was epiglottitis, a deadly but treatable bacterial infection of the epiglottis, the flap of tissue that covers the trachea during swallowing.

They aren't saying they're going to deny all treatments to you if you smoke or are fat. They are looking at restricting very specific types of treatments that tend to fail if people smoke or are overweight. If IVF fails at a 50% greater rate in women who smoke and it costs $15K per cycle on average, it makes sense to ask women to stop smoking before requesting IVF. To do otherwise is just throwing away taxpayer money.

First smokers and obese

Then, people with Aids

Then, Heart Disease

Then, various genetic diseases specific to ethic groups

Then, Altzheimers and Dementia

The elderly (we could certainly save costs with less nursing homes)

And the list could go on and on until many are weeded out.

The thought of this beginning should be frightening.

The way the UK system is set up, it considers the likelihood of success as well as the quality of life that could be obtained from the treatment. It sounds cold but there is a point where it is just a waste of money to provide certain treatments which are likely to fail or will only provide a minimal benefit. Would you spend $100K on a treatment that would give you one extra month of life if that month would be spent in pain in a hospital bed? Or would you spend that same $100K to provide health checkups to hundreds of people? These are the very real conversations that have to take place when you ask someone else to pay your medical bills for you. The funds to pay for these are not unlimited.

Um... exactly what is it that makes you think gay people are at greater health risk...?

My wife's entire family are obese, by definition, a little fly in the ointment called "genetics". They are also predisposed to other nasty issues, like diabetes, cysts, and a few other blessings of human life. They live with it, regardless, trying to do the right thing, but knowing they're star-crossed. Big Pharma rears its ugly head by profiteering - several of my wife's drugs increased obscenely - one 1000% (no, that's not a typo, one-thousand percent).

The future of this type of thinking leads down a bad road. As far as "healthy" lifestyles go, in a perfect, one-size-fits-all world, that might hold water, but it's not realistic for many. For one thing, medicine can't seem to make up its mind what's "healthy", although they keep publishing new "food pyramids" and "guidelines", while ignoring much of the wisdom in Eastern medicine. There's no easy answer, but one thing is certain: the cost of medical care is off the scale, and the entire system needs to be reformed. When you can buy drugs in other countries for a fraction of what the US profiteers charge, there's something amiss, and that something is corruption and usury.

One of the reasons drugs cost so much in the US is that the profit is used to offset the non-profitable sales elsewhere. Not sure if this started out as a 'compassionate' practice to help those in poorer countries or if the dictates of the governments in those areas limit what can be charged so marketshare is maintained with the sales but the profit needs to come elasewhere, or maybe something else. I know the madated testing in the US is costlier than most, if not all, other parts of the world so there is an implicity higher cost due to increased regulation (which does not necessarily mean safer products though ti has that effect sometimes). I'd deny antiobiotics to African tribes who continually get their drinking water downstream from where the wash the dung off their cattle despite being told it's the cause of illness. It makes for more drug resistant organisms, which eventually make their way elsewhere, and really doesn't help the health, in the long-term, of those who insist on drinking feces contaminated water.

I totally agree with Elegy.

I haven't seen people touch on IVF. Who is to say if a woman is promiscuous. My friend got a PID from her husband. Would you deny a woman the chance to have a baby because of the mistakes of another person? People are too easy to assume the worst.

Frankly, I think this whole issue is bs. And when it comes right down to it what's everything about? Money, pure and simple.

Dear Tranquili: try living without money. Your last comment is quite general, but in the real world, where real people have to make some seriously real decisions, with other people's money (taxpayers), sometimes a somewhat harsh decision has to be made. Note: here in London, Ontario, Canada, there is a heart procedure done that is a health measure, but those patients who are overweight, smoke, & drink to excess, are put to the bottom of the waiting list. The doc tells the patient exactly what is going on, so the patient can make a rational decision. Some people just don't get it: just because we have public health care does not mean you can do whatever you want, not take care of oneself, and expect the health care system to step up and do the repairs. We all need to be reminded that we must take care of ourselves as best we can. Yes, there are situations that need to be reviewed on an individual basis (i.e. contracting P.I.D. from another person), but for the most part, obesity, alcoholism, drug addiction, are all preventable, and we have the stats to prove this. Just because a procedure exists does not mean that everyone gets to have it: as stated by another commentor above, all factors must be taken into consideration, and the U.K. public health service is now forced to make some hard decisions in order to balance the budget. Sad, but true. Economics play a big part in any public service. The "take care of me at any cost" mentality has to stop. No government body can endlessly provide for the public. Don't like it? Raise the money yourself, and get private health care. The two tier system is emerging here, and I suspect it's happening in the U.K. as well.

Wrong, scottywi. I am in the healthcare field and the largest number of health care dollars is spent on problems related to the beginning and the end of life. Newborns and seniors. Smoking and obesity are not really problems with this segment of the population.

The thing that people forget / overlook is that once / if you eliminate one behavior / problem the next highest one on the list BECOMES the HIGHEST, and therefore becomes the target for elimination.

This holds true in many areas affected by legislation. If allowed to take place the eventual outcome would be a world full of drones alll eating the same diet, living the same lifestyle, limited to the same narrow set of choices across our daily lives. Except of course for two "fringe" sets - those wealthy enough to buy their way around the restrictions, and those radical enough to simply refuse to be part of the "system". NOT the kind of world I want to live in.