Human healthcare would be much more affordable if it operated on the veterinary model.
'Nails cause problems when they pass through a bovine digestive tract.'
'Well, let's keep them from passing by feeding cows a magnet.'
Problem practically solved.
'Nails cause problems when they pass through a bovine digestive tract.'
'Well, let's keep them from passing by feeding cows a magnet.'
Problem practically solved.
Animals often have relatively short lifespans. For cows its about 2 years for beef and 6 years for dairy. Would these methods work for animals that live more than a decade?
Yet for people medicine that's anathema.
Instead, we hide the cruel economic reality behind intermediaries (insurance companies, public hospitals, etc.) and then are shocked when it still leaks out.
No country without infinite money can afford to spend whatever it takes, on everyone, forever.
Auguste Escoffier said that 2 years was much too young; you couldn't make good beef stock from such young bones. He said that you had to go to France to get 5-year-old stock bones, the British slaughtered them too young. This was in the early 20thC.
A medical doctor.
While the joke is there, there are single species veterinary practices.
“Kill the patient”
Problem practically solved?
Much more affordable, sure, but not better in any other measure.
There's always a cost-benefit calculation, and the answer should never be 'Whatever the cost.'
You think like an insurance company: completely detached from reality.
At some point during this process it became clear to me that a "whatever the cost" approach is understandable but wrong. We're all going to die. If an intervention can restore somebody to health, to give them years of a good life, that's great. But an awful lot of money is spent on what seemed to me like prolonging the misery. That's not something I want for myself, and it's definitely not something my mom wanted. So as long as there was some hope of more good time, we fought and fought hard. But when hope ran out, we were off to hospice with no regrets. She died peacefully, surrounded by loved ones. It was a much better death than having a lot of futile last-minute interventions.
Speaking of which, if this makes sense to you, make sure your loved ones know your preferences. We had all done living wills years before, and it was such a balm to know exactly what she wanted. I've used Five Wishes for this, and I'm told there are other, possibly better options now too.
It's easy to say that sort of thing, so everyone does. It makes plenty of sense.
People don't want to die in the hospital or go through hell in their last days or weeks.
But nobody wants to die right now, ever. No matter what they said before or what papers they signed.
The standard picture, the logic, makes perfect crystalline sense up until there is a choice between going to the hospital right now and living an undefined amount of time, maybe only a day or a week, but longer than the next few minutes.
> But nobody wants to die right now, ever. No matter what they said before or what papers they signed.
Plenty of people recognize when it's time. When my mom was diagnosed with glioblastoma, her surgeon said, "This is what you will die from." That's hard to hear, but people can definitely take it on board. To realize that it's not a choice of whether, just how. Take, Brittany Maynard, who had the same thing my mom did: https://en.wikipedia.org/wiki/Brittany_Maynard
I can go as far as agreeing that American culture has a lot of collective anxiety about death, and a consequent refusal to deal with is calmly. But there are plenty of other approaches to that. Like the European movement known as Death Cafe: https://en.wikipedia.org/wiki/Death_Cafe
Or the (sadly now defunct) Zen Hospice here in SF: https://www.businessinsider.com/photos-of-zen-hospice-projec...
Many things in our lives can be scary. But we can shape our relationships to them. And given that death comes to all of us, I think it's worth taking the time to get on good terms with it.
Thank you for being relatively polite.
All of the replies to my original comment have veered off from what I tried to express with the phrase "right now".
I was alluding to a situation with rapid terminal cancer much later than diagnosis, but earlier than morphine + the end of communication. The fentanyl or oxycontin stage, as I recall it.
I think most likely if you are ever so slightly insulated from such a situation, you might not realize it.
Having a parent die of cancer when you are ~7 may not prepare you for having a parent die of cancer when you are ~37. That is how I see it now.
She stopped eating and drinking because she knew it was time. That was a sort of last gift, not having to see her languish for weeks.(although I will never stop being bitter about being unable to have a proper funeral and memorial service).
The current suicide rates say otherwise
I’ve witnessed two elderly people in my family with cancer in severe pain just ride a morphine drip waiting in anticipation for death. The only reason they didn’t euthanize is because it isn’t legal.
When a person can speak, and change their mind, and everyone involved in care isn't present at a particular instant or on the same page with what to do.
If that clarifies.
I can see going for a more costly treatment seeming more appealing psychologically though.
Healthcare budget is not infinite but in most countries, it’s high enough per operation that, for a given individual, it’s virtually infinite.
Insurance companies don’t care about the benefit, they just want the cost to be low, it’s not the same thing.
Also underappreciated, at the end of the day:
{insurance premiums} >= {average cost of care}
If cost of care increases, premiums must increase as well.
There are no healthcare system in the world where the budget is “high enough to be virtually infinite”.
All health systems are all heavily, heavily constrained by budget. The US system is the least constrained (i.e. if you want the latest cancer care paid for, the US is the place with the highest probability it’ll happen), but since there are thousands of insurance plans it’s not even and any two patients may have plans that make different trade offs.
And governments do the very similar math as the insurance companies when it comes to cost-benefit analyses - that’s how they design their benefit offerings.
The difference between systems like Canada (with universal care) and the US is that in Canada the end user doesnt see how the sausage is made.
That’s because the trade offs are the same for everyone and doctors know a given trade off has been made and the technology that is not paid for is just not even brought up to the patient.
Tripling the amount you pay the vet does not increase the final profit margin of the animal, so you simply do not. If basic treatment costs more than the animal will generate in its life, you don't treat the animal.
Thinking that any random farm animal is worth infinite medical resources is completely detached from reality. The animal is not worth it. There's not one single reason to pay more to maintain an animal than the money you get out of it. Not in this context.
- they can self-prescribe
- they commonly use, unlike human doctors, euthanasia to end suffering
- they became vets because they really like animals, but many owners seem more concerned with their pocketbooks
Lagniappe: https://www.youtube.com/watch?v=JChwFoCxVC8
Social isolation + a business where the business often runs counter to your moral preferences = a tough life for both
The "maybe next year" line gets me every time: https://m.youtube.com/watch?v=ZRDaPEaDJ7E
It's literally a medical science degree with a speciality. The same degree that can get you a very highly paid jobs elsewhere yet it doesn't pay that well. You'll likely end up in a poorly paid 24hour live-in clinic with horrible pay and hours surrounded by euthanasia and the associated grief non-stop all the while with those same drugs sitting there. The mortality rate is so horrific that news of another suicide from the graduating year becomes a 'we've lost yet another one' type of statistic.
It's not often you ask someone to give a late teen thoughts on their upcoming career choice and have them rightfully say 'Don't! It's not worth it!' but this literally happened with vet science in my family.
You never really been Karened until you’ve been crazy cat lady Karened.
I know of a number of large animal vets that retired and enjoyed many years of retirement. Perhaps being in the large animal practice where decisions are made on economics and not emotions helps them survive. Those vets also did small animals but it was probably more of a sideline for them.
In general though large animal rural vet work is smoother sailing than the small stuff (from conversations I've had thanks to a farm background and to having developed a bit of animal history recording software for agistment | stud records some decades back).
Perhaps the difference is that vets can both prescribe and dispense drugs, while human doctors often need to have a pharmacist dispense the drugs.
A more apt comparison here would be vets throwing pharmaceuticals and radiation at cows who ingested metals rather than a more simple solution intervention.
1. https://www.theatlantic.com/magazine/archive/2023/06/canada-...
There's something weird about letting people who are happy with life (read: society) choose to force someone who isn't to continue living, against their wishes.
"Bankrupt and undignify the patient and their family with needless, hopeless treatment."
Humane, functional american healthcare.
XYZ develop more disease -> don't allow reproduction