Because you know this will cause controversy

[Shroom Man 777]

Which has dick-all to do with me... how, exactly?

Ah, that's right. I forgot that each of you have to work a little harder to impress every one else of you every time there's a self-described "libertarian" on-board, no matter how different in ideology. Well, don't let me distract from your circle-jerk.

Weren't you talking about how a volunteerist solution would be better than a statist one? Maybe I'm confusing this thread with another one.

In an America long ravaged by inadequate health care and the absence of government-sponsored UHC, where are these volunteerist organizations?

Let's form one. You and I. Let's start it up. Right now.

... No?

Sure. How'd it work?

[Einzige]

Are you that fucking stupid? My concern here isn't for the poor or the middle-class -- it's for the elements of society (the addicts, the AIDS-ridden) that you would exclude from the system.

So, you WANT to waste organs on people who have a significantly higher chance of ruining them as others?
Great, let's keep the rich, spoiled alcoholics alive and let the others die!

Seriously, HOW do you justify this?
And don't say "it's discrimination" - because it is not. Unless you define discrimination radically different from everyone else.
So, is it discrimination to let someone who has a sunburn wait and instead treat someone with a stabwound first? Or that someone with AIDS get's more treatment time than someone with a cold?

Your policy would cost numerous human lives, shitstain - adress THAT.

Besides, you did not even adress the sheer costs of an organ transplant even if the organ is available - which would RISE under your system, since you would also have to pay for the organ.

RAWR! RAWR! POPULIST OUTRAGE! I AM ANGERED! RAWWWWWWR!

... No, you fucking twat. Unlike you, I'm not sociopathically devoted to the survival of the 'most deserving'. I'm not arguing for "wasting" anything on anybody, though you apparently believe that saving certain kinds of life is 'wasteful'. I'm arguing for as broad an approach as possible to this issue, an inclusionary, rather than an exclusionary, policy that does not condemn to death those existing on the medical fringes.

You've openly accused me of being a Nazi, but you've been the monster all along.

[Einzige]

Sure. How'd it work?

Are you good at computer programming?

[Shroom Man 777]

RAWR! RAWR! POPULIST OUTRAGE! I AM ANGERED! RAWWWWWWR!

... No, you fucking twat. Unlike you, I'm not sociopathically devoted to the survival of the 'most deserving'. I'm not arguing for "wasting" anything on anybody, though you apparently believe that saving certain kinds of life is 'wasteful'. I'm arguing for as broad an approach as possible to this issue, an inclusionary, rather than an exclusionary, policy that does not condemn to death those existing on the medical fringes.

You've openly accused me of being a Nazi, but you've been the monster all along.

What's wrong with prioritizing organ transplant treatments to those who would be more likely to have favorable outcomes (i.e. non-addicts, younger people, etc.) than those whose conditions are more likely to have less favorable outcomes (i.e. addicts, really old people, etc.)? In a situation where resources are tight, like in organ transplants where organs are scarce (or in disaster situations where emergency medical stuff is also scarce), this would make more sense actually. In emergency situations, it's called a triage where patients are categorized according to their conditions.

You'd really want to maximize the usefulness of organs, particularly when their supply is so short. In disaster situations, treatment is prioritized for those who can still conceivably make it, while those who are "goners" unfortunately get the short end of the stick. If organs/emergency medical stuff were more readily available, ideally everone would get it. But it's not.

Sure. How'd it work?

No. You?

Are you good at computer programming?

[Serafina]

RAWR! RAWR! POPULIST OUTRAGE! I AM ANGERED! RAWWWWWWR!

... No, you fucking twat. Unlike you, I'm not sociopathically devoted to the survival of the 'most deserving'. I'm not arguing for "wasting" anything on anybody, though you apparently believe that saving certain kinds of life is 'wasteful'. I'm arguing for as broad an approach as possible to this issue, an inclusionary, rather than an exclusionary, policy that does not condemn to death those existing on the medical fringes.

You've openly accused me of being a Nazi, but you've been the monster all along.

Where did i make any Nazi-references?

And don't waste your pathetic rhetoric on me.
It sure sounds nice, but when you only have a limited supply of aid, you give it to those that are most likely to profit from it.
Which is why you won't give a liver to an alcoholic.

But i see that you are unable to grasp that if something leads to more human lives being said, it's a good thing.
And it's not like it kills people - one of our both patients is going to die anyway, so we safe the one that has a higher chance of survival.

Go to a library and research "Triage" (or use the internet, since you propably do not know how to make resarch with books).

[Lusankya]

No. However, there are tangible differences between stolen goods sold on market and organs transferred in the same way: the most obvious is that the original donor likely had his or her organ voluntarily removed, while the victim of theft certainly did not give up his good willingly. Moreover, stolen goods, almost as a rule, are nonessential - certainly almost nobody sells essential items like food after having stolen them.

First of all, the fact that a liver is available for transplant does not mean that it was removed voluntarily.

Anyway I wanted to discuss the nature of essential vs non-essential items. See, the problem with using a libertarian system on essential items - items required for continued existence - is that the maximum cost of such an item is essentially infinite. For something essential, given a scarcity of resources, the price for said essential item will be limited not by how much the buyer will pay, but how much they can pay. Now, currently most people in the first world don't have to worry about a scarcity of food, but if there was one, then food prices would skyrocket. And the distribution of food would not be equal - it would be based on who was able to get the most. Essentially, the strongest, the richest and the most powerful. With healthcare, the maximum cost is, once again, what people are able to pay. You do not get people thinking to themselves, "Is this life-saving drug worth the cost?" Instead, you get people thinking, "Can I afford this life-saving drug?" Essentially, they are a captive market. Their choices are either: pay whatever price the seller is asking, or die. Sure, the seller might not be holding a gun to the sick person's head, but they essentially have the same coercive power as an armed robber, because the choice being offered is exactly the same - "give me your money or die". It is not a voluntary choice (unless you count 'dying' as a reasonable alternative), and if the customer has no choice in the matter, then why should the seller's choice be limited only by the size of potential customers' wallets? Is it an ideal or even a good society where one side of a transaction is coerced into the transaction, while the other is free to sell high, sell low, or not sell at all, depending on how they feel?

For non-essential items, the free market works much better. The reason for this is because they have an actual choice in entering the transaction. Unlike with the life-saving drug, the customer has the option of just walking away. When the customer has that power, the seller has no choice but to offer the item at a reasonable price. And if they don't - well, that just means that the customer doesn't get to play their PS3. Diddums.

Anyway, what this results in is that essential items and services need to be managed by something with a wide enough understanding of issues that they can be provided to the population as a whole without leaving gaps, as well as the coercive power to stop the richer/more powerful/stronger members of society or groups or people from misallocating those resources, because if essential items and services are misallocated, people will die. And acting on a voluntary basis, people will misallocate resources, because on average people with resources think that spending tens of thousands of dollars sending their sons and daughters to study overseas in a country of their choice is a better use of those resources than ensuring that the local public school has adequate facilities. (After all, the better parents, like mine, sent their kids to private school.)

If there is an excess of essential items, then the excess can quite happily be traded voluntarily, but this can only happen after the essential demand has been met.

Which, again, isn't saying I favor one, but that I believe any system that excluded certain persons from its rationing system would certainly give rise to one, which may very well have negative repercussions.

It is worth noting that in the OP, the woman who was refused a liver due to the rationing system ended up dying sooner due to the operation than she would have had she not undergone the operation.

What can we learn from this? - The rationing system is there for a reason. Not only did this woman die sooner than necessary, but she also denied the liver to some other person, who had a better chance of making better use of it than she did. This was exactly the kind of situation that the rationing system is supposed to prevent.

Because I'd like to try to stay on-topic as much as possible.

Eh. If it gets too off-topic, a mod will split it.

[Broomstick]

What a great way to intentionally contort my arguments, Broomstick! Soon enough they'll be as limber as your own intellect, no doubt.

Ah, so you acknowledge I am more mentally more adroit than you? Excellent.

At present, there is no alternative to organ transplant - well, there's dialysis for kidneys, and insulin for diabetics, but neither of those is as good as a working organ.

Not medical alternatives, you dolt: accessibility alternatives.

It is medical factors that limit organ transplant - what "accessibility alternatives" will result in more organs? Because without more viable organs there will always be hard choices regarding who gets them.

Let's deal with another little fact: all the money in the world will not make an incompatible liver suddenly compatible with the patient. If there is no organ compatible with a particular patient then it doesn't matter how many other organs exist for transplant - they're useless to that patient. So even if you were (hypothetically) the wealthiest person in the world there may still be no compatible liver/kidney/whatever available to you.

In other words, money can't change biology.

I know this. That's the crux of my argument: by intentionally limiting the available organs to selected individuals, you will have inadvertently created the motive for the formation of a black market in organs by those excluded from the system. And who will be the ones volunteering their own non-essential organs? The poor.

A lot of organs used in transplants are NOT "non-essential" - like hearts, for example. Most livers are of cadaver origin because of the high risk to the donor in a live liver donation. Good luck getting people to "volunteer" a lung - and in any case, single lung transplants have a low success rates, the preference is lung+heart as the success rates are MUCH better. While technically a pancreas isn't essential to life you only get one, no one will be selling theirs while still alive.

Kidneys are about the only organ where a viable, actual market for the organ could be created and sustained - everything else, no, all the money in the world isn't going to make significantly more organs avaiable or "accessible" - unless you want to condone killing one person for the benefit of another.

Let's clear up a factual error here - not only can't the poor afford an organ transplant, neither can the middle class. In fact, most of the wealthy of the world can't afford it.

Are you that fucking stupid? My concern here isn't for the poor or the middle-class -- it's for the elements of society (the addicts, the AIDS-ridden) that you would exclude from the system.

As I said, there are medical reasos people with HIV are excluded from organ transplants. Addicts are not permanently excluded.... but they do have to be drug-free for an extended period of time and abstain from recreational drug use ever afterward. Why? Because if they don't they'll kill their new organ and, in many cases, die. That's not being mean, that's dealing with reality.

Other people excluded are those with many types of cancer - because the anti-rejection drugs will allow the cancer to come back and kill them rather quickly. Past a certain age people are not considered for transplant simply because they are not physically capable of tolerating a surgery of that length for any reason.

All the money in the world will not change these facts.

Second - people with AIDS are turned down for organ transplant NOT because they're homosexual or drug users or "bad people" - they're turned down for medical reasons. Most of the drugs that suppress the HIV virus are damaging to organs, and thus would destroy a donated organ. They also have that fucked up immune system, which will complicate maintaining a transplanted organ. A transplant is unlikely to prolong their lives significantly. Thus, the organs go to someone more likely to live years beyond the transplant.

*sigh*

Once again: I know this. I'm not arguing that there's some sinister conspiracy afoot to keep them off the donor rolls. What I am arguing is that, by intentionally excluding them from a more centralized form of organ donorship - as Stas Bush and Duchess argue - you'll give them that much more incentive to look for alternatives to acquiring organs.

There aren't any alternatives.

Do you not understand that by the time someone is on a waiting list for something like a liver they are already dying? They are terminally ill. They haven't long to live and every other alternative has already been exhausted

And, again - where do you think the money will come from?

Organ donations start at hundreds of thousands of dollars just for the operation itself - never mind the testing, the transportation of the organ (which, because speed is required, often utilizes air travel which is inherently more expensive than ground transportation), the time in intensive care, the follow up testing, the medications...

Waving money around will not make these problems go away.

Likewise, and ACTIVE drug user is a poor candidate because of physical self-abuse due to their addiction. A reformed drug user or alcohol CAN be considered for transplant... and can do well IF they stay off their addictive substance of choice. So, if the woman in the OP had gotten clean and stayed clean either she would have kept her first transplanted liver or, if not, would have qualified for a second. What dropped her off the list wasn't being a drug user - obviously, she got a first liver, so that wasn't the final criteria - but that she was still abusing.

I know that. I know that. Please fucking stop with the cloying POPULIST RAAAAAAAGE!!!!111!, as it doesn't impress me or make your arguments any stronger.

I see - pointing out facts you are uncomfortable with is somehow "populist rage". I don't think that phrase means what you think it does...

My point is that, if it becomes inherent to the system - that drug users are excluded from the rolls - they'll look elsewhere, and that elsewhere might be in struggling slums.

Again - addicts are NOT excluded from the system as long as their addiction is under control, It is NO different than requiring a former cancer patient to be cancer-free for a certain length of time prior to being considered for a transplant. It's a medcal decision based on whether or not there is an additional medical issue that would impact the likelihood of a successful transplant.

Want another example? People who attempt suicide can be denied a transplant, too - because why would you give a new organ to someone trying kill himself? But it's not a lifetime excusion. IF the underlying mental disorder leading to suicide attempts is under control for a sufficient period of time such a person could, in fact, be given a new organ.

As for the last part of that statement - you think people will be performing actual transplant surgery in a SLUM???

How do you think? Shady surgeons will offer their services to the highest bidder, with specimens selected from the permanent underclasses.

My god - you have NO CLUE how organ transplant is done, do you? It's not something you could do in a gargae with jury-rigged equipment and send the person to recover in a motel room! The surgeries last 12 hours, sometimes more. It requires a surgical TEAM, not just a doc with a razor blade. It requires round the clock high skilled nursing care for days, at least, after the surgery. It requires highly sophisticated testing to check for rejection. It requires a pahrmacy stocked with expensive drugs.

This is not something you can hide in a back alley, you know.

Where will these additional organs for this market come from?

From the poor with nowhere left to turn.

What, you think people are going to willing be butchered so someone else can have their organs, or will you just legalize murder?

As I said - you might get a market for kidneys, but for other vital organs...? No. India does have a market where poor people are selling their kidneys, but it's leaving an awful lot of human wreckage in its wake through sloppy surgery and lack of follow-up care. Poor Indians are being maimed for life so rich people can buy their kidneys. I find that repulsive. For the rest - you can't have a living heart donor.

How will poor people - who, by definition, have little money - get the cash to pay for these hypothetical organs?

They're not going to pay for the organs, moron. They're going to be selling them.

You can't sell your heart while you're still alive. Well, alright, maybe you can - but you're basically butchering one person to save the life of another. Your proposed system is monstrous.

[Einzige]

What's wrong with prioritizing organ transplant treatments to those who would be more likely to have favorable outcomes (i.e. non-addicts, younger people, etc.) than those whose conditions are more likely to have less favorable outcomes (i.e. addicts, really old people, etc.)? In a situation where resources are tight, like in organ transplants where organs are scarce (or in disaster situations where emergency medical stuff is also scarce), this would make more sense actually. In emergency situations, it's called a triage where patients are categorized according to their conditions.

I have no issue with prioritization; that is both rational and efficient. I do have a qualm, however, with deliberate exclusion, particularly under the guise of organ shortage. And so I again endorse Alphawolf5's strategem:

I actually wouldn't mind a system in which the US Government bought organs in the form of cash or in the form of college funds for around 100-250,000. Since if the Government is doing the buying the issue of the poor not being able to afford is eliminated and dialysis actually cost more then that usually. The only problem is people would believe that it'd prey on the poor due to it being seen as a way to get a quick buck but honestly the process to becoming a donor is so long and full of so many roadblocks that I doubt it'd be as bad as people suggest.

I myself would set an income cap of ~$15-20,000.00, so as to make sure this is only a measure of last resort. But it's certainly a solid enough plan.

No. You?

Unfortunately not. One of the things I want to work on is educational preparedness: in the event of a national catastrophe or collapse that renders the school system inoperable, I want to make sure that there's a way for as many people as possible to become as self-sufficient as possible in the area of education. But that, alas, is for another day.

[Shroom Man 777]

What's wrong with prioritizing organ transplant treatments to those who would be more likely to have favorable outcomes (i.e. non-addicts, younger people, etc.) than those whose conditions are more likely to have less favorable outcomes (i.e. addicts, really old people, etc.)? In a situation where resources are tight, like in organ transplants where organs are scarce (or in disaster situations where emergency medical stuff is also scarce), this would make more sense actually. In emergency situations, it's called a triage where patients are categorized according to their conditions.

I have no issue with prioritization; that is both rational and efficient. I do have a qualm, however, with deliberate exclusion, particularly under the guise of organ shortage.

Then don't exclude them. Just put them lower on the list compared to those people who are less likely to screw the operation up, or who are more likely to have favorable outcomes (and thus not squandering the organs). They'd be in the same bracket as, say, people who have other physiological problems with organ transplants (i.e. tissue/organ rejection problems, incompatibility, whatever). Or maybe lower, since they're deliberately making lifestyle choices that actively make the therapeutic outcome of organ transplant less likely. Their ranking would improve if they made lifestyle adaptations to make therapeutic outcomes more likely - like by stopping their drug addiction, via rehab or something.

And so I again endorse Alphawolf5's strategem:

I actually wouldn't mind a system in which the US Government bought organs in the form of cash or in the form of college funds for around 100-250,000. Since if the Government is doing the buying the issue of the poor not being able to afford is eliminated and dialysis actually cost more then that usually. The only problem is people would believe that it'd prey on the poor due to it being seen as a way to get a quick buck but honestly the process to becoming a donor is so long and full of so many roadblocks that I doubt it'd be as bad as people suggest.

I myself would set an income cap of ~$15-20,000.00, so as to make sure this is only a measure of last resort. But it's certainly a solid enough plan.

That sounds... odd. I'm unsure about buying organs from people. Maybe cash incentives for getting yourself a donor card so that when you die, your organs get harvested and your grieving family gets a nice little compensation. Or something. Meh. Whatever.

[Broomstick]

Sorry guys, had to leave for a bit because work called. Now, where were we...?

RAWR! RAWR! POPULIST OUTRAGE! I AM ANGERED! RAWWWWWWR!

Oh no! He's HULKING OUT!!!!!

(wonder if he can afford treatment for high blood pressure....?)

... No, you fucking twat. Unlike you, I'm not sociopathically devoted to the survival of the 'most deserving'. I'm not arguing for "wasting" anything on anybody, though you apparently believe that saving certain kinds of life is 'wasteful'. I'm arguing for as broad an approach as possible to this issue, an inclusionary, rather than an exclusionary, policy that does not condemn to death those existing on the medical fringes.

The people on the "medical fringes" are likely to be poor transplant candidates for medical reasons, having a high chance of being a living embodiment of the old joke "The patient died, but the operation was a success!"

I'm curious as to how you view giving a scare resource to the "most deserving" as "sociopathic". Seems to that is actually pro society. As opposed to your system, which is based on survival of the most selfish wealthy.

You've openly accused me of being a Nazi, but you've been the monster all along.

Where did i make any Nazi-references?

He's getting all emotional - like a girl, only worse. You, Serafina, didn't call him a Nazi at all.

I called him a Nazi!

The pathetic little shit can't keep straight who he's talking to. Or who's talking to him.

[Serafina]

Well, i would say that he is even WORSE than a Nazi -they at least had an interest in the "good of society", as wrong and narrow as their sight of society they might be
He, however, is a totally selfish prick, or at least advocating a system favoring no one but selfish pricks.

So there you have it - is STILL did not call him a nazi
Let's see was our cute little hulk/atlas wants to say to that.

[Broomstick]

Well, i would say that he is even WORSE than a Nazi -they at least had an interest in the "good of society", as wrong and narrow as their sight of society they might be
He, however, is a totally selfish prick, or at least advocating a system favoring no one but selfish pricks.

I suspect the only reason the Nazis didn't kill their undesirables for organs is that transplant technology didn't exist back then. They certainly didn't seem to have an issue with converting people into useful products such as using human hair in felt making. And there's that reputed soap making, the human skin lampshades... Unquestionably they recycled dental work. There was that horrid experiment that Mengele did that involved sewing two Roma children together to produce a "conjoined twin".

The Nazis also took Jewish, Roma, and other infants of undesirables that were sufficiently Aryan in appearance and gave them to infertile German couples to raise even as their biological parents were being killed.

While the Nazis certainly did not perform organ transplants it's an interesting question of whether or not they would have if they could have.

So there you have it - is STILL did not call him a nazi

No, you haven't.

Let's see was our cute little hulk/atlas wants to say to that.

Hmm.... wonder if he's gone off to sulk?

[Wing Commander MAD]

Einzige, so if I am understanding your point of view correctly(or at least part of it) your concerned about people being excluded from the possibility of transplants (or presumably being so low on a ranking scale as to be excluded informally) creating a blackmarket where those excluded would be buyers of the organs, with the organs in question coming from the poor. Your concern, at least in part, then is with exploiting the poor either by the poor being coerced into selling their organs, or outright murdered for them?

Your proposed solution is to apply a free market approach, which will presumably prevent this blackmarket from forming. This may or may not save as many lives as a needs based approach (not what your proposal seems to be trying to address), but at least the poor won't exploited by people who are denied an organ via normal triage proceedings and are willing to prey on others. Thus, this creates equality, somehow, by removing potential abuses that may arise as a result of certain kinds of discrimations being acceptable. Basically, prevent various potential forms of discrimination that could change based on society's whims, by introducing one well known and understood form of discrimination and thus preventing these other nebulous discriminations from ever officially entering into the organ transplant system. Is this basically the jist of your argument, or have I misunderstood something?

Note guys, I am not taking any particular stance on this. I merely wish to make sure I'm understanding Einzige's argument correctly.

[mr friendly guy]

Hey if anyone is still interested, the WA government has said it is unlikely to ask the family to repay the $258 000 they lent them. It was in today's West, but I can't find the equivalent online article.

Fuck that. Seriously, the family could just go on Today Tonight or whatever passes for current affairs these days, sell their story, then have a charity drive from her supporters. If that still isn't enough, put it in a high interest account (the loan has to be repaid interest free in 2 years) and then run another charity drive before its due to be paid.

To top it off the article has the family saying Claire was oh sooooo accepting of her fate and didn't want to take someone else's place. Thats why she wanted to be put back on the organ waiting list. Lets quit with this pretending that she is oh so noble. She had her chance and she blew it with drugs. She had a second chance and she blew that as well, with drugs again. Her family gets a very generous offer of an interest free loan, which was wasted because she would have lived longer if she didn't have the operation. And now they get a further bonus by not having to repay the loan.

Man, I am going to ask Kim Hames the health minister for $258 k to satisfy my imaginary gambling addiction, or maybe it will be a shopping addiction. I could develop one of those for the loan which doesn't have to be paid back. Meanwhile health workers have to complain to the government pay roll to be paid what they are due because incompetents run it, not to mention they want us to run services even more efficiently with less money.

Fuck you Kim Hames.

[PainRack]

Hey if anyone is still interested, the WA government has said it is unlikely to ask the family to repay the $258 000 they lent them. It was in today's West, but I can't find the equivalent online article.

Fuck that. Seriously, the family could just go on Today Tonight or whatever passes for current affairs these days, sell their story, then have a charity drive from her supporters. If that still isn't enough, put it in a high interest account (the loan has to be repaid interest free in 2 years) and then run another charity drive before its due to be paid.

Thanks for contributing more cash to Mount E?

I mean, seriously, I known foreigners and stuff, they like Mount Elizabeth Hospital. And certainly, out of the private hospitals here in Singapore, they're one of the best and most comprehensive. That doesn't make them any less money-grubbing arsehats who's willing to promise the sky and moon.

[mr friendly guy]

Thanks for contributing more cash to Mount E?

I mean, seriously, I known foreigners and stuff, they like Mount Elizabeth Hospital. And certainly, out of the private hospitals here in Singapore, they're one of the best and most comprehensive. That doesn't make them any less money-grubbing arsehats who's willing to promise the sky and moon.

Just make sure the Singapore Ambassador personally thanks us for stimulating their economy.

Australian tv mentioned the government are being coy about whether they need to repay the debt. Apparently the $258 K isn't enough as the family claim to be in debt of $400 K, which begs the question, how much does it cost for the length of stay in Mount E anyway? Especially given that the AUD is stronger than the Singapore dollar.

Meanwhile payroll has agreed that they underpaid me again, oh by an order of more than $560 in one fortnightly pay period. Because apparently their software can't perform primary school level of addition. While I don't have any ill will against the family, I do think that the money shouldn't have been provided, and the fact the government is trying to cut the health budget by 3% while throwing such sheenanigans like under paying health workers, but at the same time is quite happy to lend money to a druggie for the publicity compassion value smacks of bullshit and rewarding mediocrity. But then this is the same government that gave money to fat cat public servants so why am I not surprised.

[times]

Uh... yeah. And when you do a live liver transplant you cut out half the liver which leaves....well, presumably just have the reserve. Down to less than 50%, right? Assuming nothing goes wrong. And don't forget, anti-rejection drugs have side effects. To put it bluntly, they're toxic. And what organ is the main de-toxifier? The liver. Which you have just cut down the 1/2 capacity. So don't screw it up, 'cause really with a live donor liver transplant you're only getting half a liver. Treat it gently til it all grows back.

In case it isn't clear, I was talking about the donor, not the recipient. Under other circumstances the risk may be justified, but the fact is, a live liver donor takes a hit on his own liver function and there is a real risk of debility or even death.
This statement in particular.

What level of liver function is medically "recommended" for being a liver donor?

[Broomstick]

What level of liver function is medically "recommended" for being a liver donor?

Can't quote numbers, but clearly you're liver has to be healthy enough that you can lose 1/3 to 1/2 of it and still remain healthy. So... pretty healthy.

[PainRack]

Just make sure the Singapore Ambassador personally thanks us for stimulating their economy.

Australian tv mentioned the government are being coy about whether they need to repay the debt. Apparently the $258 K isn't enough as the family claim to be in debt of $400 K, which begs the question, how much does it cost for the length of stay in Mount E anyway? Especially given that the AUD is stronger than the Singapore dollar.

Hmmm... probably have to ask a friend of mine working there, but the first operation done in the 90s cost 30k, barring long term treatment. From what I understand, the hospitals, well, public hospitals anyway package treatment together as a set package, with the caveat of additional expenses from complications.
http://infopedia.nl.sg/articles/SIP_86_2005-01-28.html

The operation itself cost S$30, 000 but the maximum estimate for a year's treatment was S$100, 000. This covered costs for pre-and-post-surgery treatment, outpatient and in-patient treatment, hospital charges, laboratory tests and medication. Since the liver transplant project was a pilot one, NUH did not subsidise the operation

Daily rates at Mount E is 684.80 for the ICU,HD is 577.70. So,figure HD for the donor, ICU for the recipient, mutiple that a few days...... add a couple courses of abx and stuff.....

http://www.parkwayhealth.com/patients-v ... mrates.pdf

I still have no idea how it runs up to 400k. I can believe it does run that high, but I can't figure out how. What's the normal treatment/rehab basis anyway? I doubt that they're giving her caspofungin and voraniconazole, so, I'm stuck at what drugs they pumped into her to account for a missing 100k.

Meanwhile payroll has agreed that they underpaid me again, oh by an order of more than $560 in one fortnightly pay period. Because apparently their software can't perform primary school level of addition. While I don't have any ill will against the family, I do think that the money shouldn't have been provided, and the fact the government is trying to cut the health budget by 3% while throwing such sheenanigans like under paying health workers, but at the same time is quite happy to lend money to a druggie for the publicity compassion value smacks of bullshit and rewarding mediocrity. But then this is the same government that gave money to fat cat public servants so why am I not surprised.

But.... But..... Death Panels! Mother of kids! Don't let the clerk stand between you and your doctor!

Just how bad is payroll over there?

[mr friendly guy]

I still have no idea how it runs up to 400k. I can believe it does run that high, but I can't figure out how. What's the normal treatment/rehab basis anyway? I doubt that they're giving her caspofungin and voraniconazole, so, I'm stuck at what drugs they pumped into her to account for a missing 100k.

She was operated on mar 18, died around april 1. She had 2 operations, the transplant plus the one for complications. Lets be generous and assumed she stayed in ICU ($684.8 with GST / day) for the 2 days prior to death and HDU ($577.8 with GST / day) for 3 days post op (just in case, although she initially seemed to be recovering well). Lets also be ultra conservative and assume the operation for the liver costs $60,000 (inflation of 3-4% would mean the costs doubles since 1990 in 18-24 years), and just give the second operation at the same cost. Lets assume she stays in the interim after getting out of HDU and before into ICU at a single room at 492.20 $Sing a day. Lets give the donor a 3 day stay at HDU. This still comes up to $130 000 Singapore without taking into what drugs they gave her in those 2 weeks. Thats about $100 000 AUD at current exchange rates. Lets not forget that as a foreigner she should be entitled to GST back.

I have no idea where this extra money is coming from. Plane trips for an adult up and back from Singapore is less than $1000 AUD. The lodger for the hospital is only $80.25 per person. I would be somewhat perplexed if they chose to stay at an expensive hotel around Orchard road.

In any event the government has now declared that the family must pay the money back, as they should. I bet you they were trying to sound out the public's mood before making a declaration. However the government are already getting loads of requests from other people requesting government funding for medical problems. I said it at the beginning, this genie is out of the bottle and it would be hard to put it back in.

Just how bad is payroll over there?

You can see my rants previously about it. It wasn't always this way, but then they decided to centralise things. One of the interns said she had to call them every payday because they inevitably make a mistake. Generally if its only a tiny mistake I let it slide, although I realise even if they underpay every worker every pay day by say $20, it will add up to a lot of money. This is of course the mistakes they fess up to. Other times they have blatantly broken the agreement (and in a freudian slip their operation freely admitted to me of NOT following the award) and as a result are being taken to court.

One of the acts of bastardry they do is to say you must PHYSICALLY work the overtime in the TWO WEEK PAY PERIOD, which runs into the problem of what happens when you work say 21.5 hours overtime in the first week (based on the roster for a medical registrar this is the maximum they will roster you on for at my hospital), and take paid annual leave (or some other leave) on the second week. Why you get paid zero overtime (the extra hours are paid at normal rates), because since you didn't work the second week you physically didn't work any overtime in the two week pay period.

[Questor]

One of the acts of bastardry they do is to say you must PHYSICALLY work the overtime in the TWO WEEK PAY PERIOD, which runs into the problem of what happens when you work say 21.5 hours overtime in the first week (based on the roster for a medical registrar this is the maximum they will roster you on for at my hospital), and take paid annual leave (or some other leave) on the second week. Why you get paid zero overtime (the extra hours are paid at normal rates), because since you didn't work the second week you physically didn't work any overtime in the two week pay period.

How is this legal? I know that (in my industry, in my state) anything over 8 hours a day/40 hours in a week MUST be paid at overtime rates. Are they claiming to be able to time average over many days?

[PainRack]

She was operated on mar 18, died around april 1. She had 2 operations, the transplant plus the one for complications. Lets be generous and assumed she stayed in ICU ($684.8 with GST / day) for the 2 days prior to death and HDU ($577.8 with GST / day) for 3 days post op (just in case, although she initially seemed to be recovering well).

SOP is post transplant go to HD for observation before going to general ward. Not sure how new this is though or how they will play the charges. I simply assumed she stayed in HD throughout the LOS before transiting to ICU for the last two days.

Lets also be ultra conservative and assume the operation for the liver costs $60,000 (inflation of 3-4% would mean the costs doubles since 1990 in 18-24 years),

Add another ten thousand or more. The previous operation was done at a public hospital, which mean that secondary charges are subsidised. The operation won't be since its a pilot.

Its a mystery....... I simply can't figure out where a missing 100k can go to. And I'm assuming massively inflated charges, such as staying in HD for the entire LOS, adding on costs that probably shouldn't have been reflected and pulling numbers out of my ass.

Unless they did repeated PET/MRI scans..... I was counting on something like having a MRI brain/abd, a PET scan, the ops costing 150k in total, repeated CT scans and stuff. Unless I'm utterly wrong in the current going rates for an MRI scan. Or the hospital rates for abx are different. A course of cefipeme is approximately 100-200 dollars, (have to access the hospital e-pharma to check out the real price. It should be within that range.)3 weeks... that's what? 3 courses? Unless they start throwing in multiple broad spectrum abx...cefipeme, amikacin+vanco....

There's no transplant rates available at MOH, but according to the ministry, kidney/liver failure bills fall within the range of 3 thousand to 5 thousand dollars.

How is this legal? I know that (in my industry, in my state) anything over 8 hours a day/40 hours in a week MUST be paid at overtime rates. Are they claiming to be able to time average over many days?

They do the same shit here for office workers. Not sure about doctors though.

[mr friendly guy]

One of the acts of bastardry they do is to say you must PHYSICALLY work the overtime in the TWO WEEK PAY PERIOD, which runs into the problem of what happens when you work say 21.5 hours overtime in the first week (based on the roster for a medical registrar this is the maximum they will roster you on for at my hospital), and take paid annual leave (or some other leave) on the second week. Why you get paid zero overtime (the extra hours are paid at normal rates), because since you didn't work the second week you physically didn't work any overtime in the two week pay period.

How is this legal? I know that (in my industry, in my state) anything over 8 hours a day/40 hours in a week MUST be paid at overtime rates. Are they claiming to be able to time average over many days?

The overtime is usually calculated per fortnight since that is the length of the pay period. Generally its not a problem because previously they would count the week annual leave as equivalent to working that number of hours, so it you worked the usual 8-1700 in the first week you would get 7 hours over time even if you take leave the second week. Now you don't. They just give the leave in terms of monetary value as equivalent to working that whole week, but they won't use that number to calculate overtime. So in essence they say you worked under time (ie 45 hours out of 76 hour fortnight), but with the leave pay (of equivalent of 38 hours worked) you end up with equivalent of 83 hours worked. The extra 7 hours is paid at normal time instead of at overtime rates though.

I hope we win this one. People have complained to the government about this arrangement and taken it to the courts. Naturally they don't listen. I guess there aren't enough druggie doctors and complaining that the government isn't paying people properly isn't as controversial as this story.

Note - payroll has back paid several people after successful court cases regarding other screw ups. The one that pisses me off is AFAIK still being challenged.

SOP is post transplant go to HD for observation before going to general ward. Not sure how new this is though or how they will play the charges. I simply assumed she stayed in HD throughout the LOS before transiting to ICU for the last two days.

Initially she seemed to do well, so unless the private hospital was money grubbing, it makes sense to transfer them to a normal ward bed. A public hospital would not keep these people longer in a HDU when not required. Its simply a waste of resources and diverts the bed from someone who may need it.

Unless they did repeated PET/MRI scans..... I was counting on something like having a MRI brain/abd, a PET scan, the ops costing 150k in total, repeated CT scans and stuff. Unless I'm utterly wrong in the current going rates for an MRI scan. Or the hospital rates for abx are different. A course of cefipeme is approximately 100-200 dollars, (have to access the hospital e-pharma to check out the real price. It should be within that range.)3 weeks... that's what? 3 courses? Unless they start throwing in multiple broad spectrum abx...cefipeme, amikacin+vanco....

She would have had a pre-operative work up in WA when she had her first transplant. Why would they repeat most of it again? And why do a PET scan anyway? Their use is highly specified for physiological function rather than viewing the anatomy. And I really can't think why someone would do an MRI of the brain in this case.

My mum tells me Mount E is a hospital that caters to rich foreigners, but shite, the fees that must have incurred for them to use more than the $258 K.

[PainRack]

Initially she seemed to do well, so unless the private hospital was money grubbing, it makes sense to transfer them to a normal ward bed. A public hospital would not keep these people longer in a HDU when not required. Its simply a waste of resources and diverts the bed from someone who may need it.

Its an overestimate on my part.

She would have had a pre-operative work up in WA when she had her first transplant. Why would they repeat most of it again? And why do a PET scan anyway? Their use is highly specified for physiological function rather than viewing the anatomy. And I really can't think why someone would do an MRI of the brain in this case.

My mum tells me Mount E is a hospital that caters to rich foreigners, but shite, the fees that must have incurred for them to use more than the $258 K.

I was assuming they did an MRI to check any mysterious "spots" such as an abscess they detected in the abd or brain from a CT scan. I don't know what her real problem is other than she died from a post op complication, so, I'm running off scenarios that would have resulted in the most expensive solutions I can think of. Absurd, unlikely scenarios, but the idea of a 1 month stay and two operations causing 400k damages?

To put that in perspective, we had a patient stay in my haematology ward for over 6 months, including two stays in MICU. Combined that with multiple operations(I think 6 in total, if you include CVC line insertion) and I think two courses of chemotherapy, and his bills were somewhere in the 600-800k range, albeit, with significant public subsidy.

[PainRack]

Found a major cause for the massive bill inflation.

Multidisciplinary care. My friend brought up the fact that they're actually paying for multiple professors fees. So, the op itself would have not only required multiple surgeons and multiple profs, managing the transplant afterwards and the complications would have involved more disciplines, thus more professors. So, more doctor consultancy bills. I mean, its impossible for a single consultancy fee to have been 100k, but 5, maybe 6...... now, that I believe.


Another possible inflation is the loss of the medical deposit and drugs, I did point out that they're supposed to receive medication from inpatient pharmacy, which should have been refunded, but again, they pointed out that the dispensary might have been from the clinic as opposed to the pharmacy, hence, no refunds.