Trying Not to Care

By John Conway | May 28, 2009 8:35 pm

Last night, watching a recorded episode of the Daily Show from last week, where Jon Stewart interviewed Elizabeth Edwards, Stewart took the conversation in the direction of health care. At one point, Edwards mentioned that “the President of UnitedHealth made so much money, that one of every $700 that was spent in this country on health care went to pay him.” I was totally floored by this statistic – could our for-profit health insurance industry be that twisted?

So here are some facts. In 2007, according to HHS, total health care expenditures in the US were $2.2 trillion, and expected to grow at a steady 6.1% to $2.33 trillion in 2008. Others, like the National Coalition for Health Care, estimate that in 2008 it was $2.4 trillion, fairly close. Now, 1/700 of that is $3.4 billion, which is actually a thousand times larger than Stephen Hemsley, the CEO of UnitedHealth Group, makes.

So was Elizabeth Edwards wrong? Turns out, she might have been referring to UnitedHealth’s former CEO, Willim McGuire, who was ousted in late 2006 after an options backdating scandal. McGuire made $125 million in 2005. That’s a mere 1 in every $20,000 spent on health care I guess. Taking into account the stock options he sat on, it might bring the ratio down…but I must conclude that there was some hyperbole on Edwards’ part.

I forgive her, mainly because this isn’t the point. What I find truly impossible to accept is that we have a for-profit healthcare insurance system at all. As I have pointed out in the past in CV, this seems to me to be one of the clearest conflicts of interest that you could devise: reward health insurance companies and their shareholders for giving as little actual health care as possible for every dollar received. What other way is there to maximize profits? Oh, right, I almost forgot: keep the costs of health care rising so that this industry grows out of control as a fraction of GDP.

The system where we rely on our employers to provide health care coverage is broken. The rising costs have driven some employers, like the big automakers (who spend more on healthcare than steel) to the brink of bankruptcy, and have driven others to continually pare back the level of coverage for their workers. Underinsurance is as serious a problem as the nearly 50 million not covered at all. Should the particular disease you get wipe you out financially just because it’s too rare a situation to be covered by your plan? Should companies and their shareholders be making profits while our loved ones are being denied treatment? Or even denied coverage at all due to a “pre-existing condition”?

The health care companies have realized that change is coming, quite possibly in the form of a government-run alternative plan with much smaller administrative costs and no profit motive. A report appeared recently in The Washington Post that Blue Cross Blue Shield is launching a large PR campaign against the possible government-sponsored public insurance option. In addition, the health cartel has put forth a plan a couple weeks ago promised to reduce the rate of growth of costs by 1.5%, to about 4.5% presumably. Whoopie.

The right wing is fearful of rationing, long waiting times, or being unable to choose a doctor. The problem is that they simply don’t seem to give a hoot about the 50 million un(der)insured, who wait until they are terribly ill and then show up in ER’s. Guess who pays for that.

Another huge factor in the exorbitant cost of health care in the US is a topic that seems to be very seldomly discussed in the media: the end of life. Something like 27% of Medicare costs go to the last year of a patient’s life. How much of this is simply due to the fact that the patient, and their family, wants to try anything possible to achieve a cure, when in fact the doctors and the nurses know full well that the patient is terminal? Greater emphasis on counseling patients and families, plus a change in our culture that would make us more accepting of death, and an increased focus on preventative and palliative care rather than heroic but clearly futile and expensive late-stage treatments could save our society hundreds of billions of dollars per year.

I am not saying that no one should make a profit performing or delivering health care. Doctors, nurses, hospitals, medical suppliers do what they do to make a living. (Let’s leave Big Pharma out of it for a moment – that deserves a whole post by itself.) What I *am* saying is that no one should turn a profit by adding an unnecessary and bloated layer of bureaucracy. As Donald Cohen pointed out in March at the Huffington Post, the for-profit players are crying foul at Obama’s plan, essentially for a government-run Medicare-like option, because they don’t want the competition. As Cohen points out:

Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. There is big money to be made in health insurance. The top 7 “for profit” health insurers made a combined $12.6 billion in 2007– an increase of 170.2% from 2003. The same year, the average CEO compensation package for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million.

Government-sponsored single-payer healthcare, which succeeds admirably in many other countries around the world, is probably not a realistic possibility in the US. I think that the next best thing in the long run is that an array of private, not-for-profit companies like Kaiser Permanente could run the for-profits into the ground. The government can encourage the non-profits in any number of ways, with little cost to taxpayers. One way or another I hope that Congress and the Obama administration can create a viable option for the 50 million uninsured, soon.

Access to quality health care should be a basic human right in a civilized, technologically advanced society like the US. It has become our greatest shame in the world that we cannot provide that for one in six of our people.

CATEGORIZED UNDER: Health, Human Rights
  • http://coherentstates.blogspot.com R

    How much of this is simply due to the fact that the patient, and their family, wants to try anything possible to achieve a cure, when in fact the doctors and the nurses know full well that the patient is terminal?

    Oh, come on! Seriously? If that’s the case it would be just like particle physicists dumping money into their quest for the Higgs Boson when everyone else knows full well it won’t be there.

    My statement is just as wrong as yours.

    On another note, I’ve heard that Kaiser Permanente is just as bad as the for-profits in terms of denying healthcare.

  • Matt

    What I find so hilarious is that these supposed free-market boosters who believe in the unparalleled power of competition and the market are terrified that if we add competition by introducing a public plan, then the market will crumble like a “delicate flower.” Some all-powerful market indeed! The free market survived world wars, crashes and depressions, but somehow adding a public insurance plan will destroy it. Yeah, right.

    We have public schools and private schools, public mail/package services and private mail/package services, public armed forces and private armed forces, public security and private security, public transportation and private transportation, and so on. And in all these cases, the competition between public and private improves the quality of both, and considerably improves the options available to the people. Don’t like the post office? Then use FedEx. Don’t like driving a car and finding a parking spot? Then take the bus. That’s real freedom.

    So what possible argument is there for why introducing a public health insurance option would “destroy” private insurance? What makes health insurance so magically different from everything else?

    The difference is only that a major public plan has never existed before, so the private insurance companies can scare us by pretending that there’s something fundamentally different about health care.

    It’s all scare tactics. Don’t look at Britain or Canada, which aren’t even as bad as people say when you stop looking at anecdotes but instead look at statistics. Look instead at countries like France, which does have both public and private health insurance options. And lo and behold, the French are happier with their health system than anyone else in the world, and have better health outcomes and health statistics than the US by far. Surprise, surprise.

    It all comes down to money. Private insurance will undoubtedly stand to lose a bundle if a public plan becomes available. Private insurance will survive, but it will shrink. And that’s the idea they can’t stand.

    They’re not looking out for our well-being. They’re looking out for Number 1. But they can’t say that, of course. Instead, they pretend that it’s all for our benefit that they pay doctors 30% of their bills and screw patients out of needed treatment whenever they can. And how do you think they intend to lower the growth of health costs from 6% to 4.5%? Simple. By cutting care and lowering reimbursements to doctors even more.

    A typical doctor goes to school for a decade or more, endures years in residency and internships, and emerges a quarter of a million dollars in debt. And yet insurance executives, who’ve maybe done an MBA, feel entitled to treat them like servants. They treat doctors badly, too. That’s why 80% of doctors in fields that deal directly with patients—general practitioners, internists, etc.—favor a public plan.

    Why does anybody believe the insurance people, or take what they say seriously? What’s that gotten us?

  • glad

    I’m so glad that this blog has turned into yet another orifice of uninformed political ranting. That’s absolutely what I come here for (though it appears I haven’t been alone in coming here less often).

    and at matt—those public school and transportation systems tend to either be locally controlled or to be massively subsidized to break even if they’re controlled nationally. The military and national security is a whole different ball game because its arguably the essential role of the government and is foolish to include. In that vein then why should we create another unwieldy, centralized, enormous and deficit running bureaucracy when we can work to improve things such as medicare instead?

    In any event its rich to have people like matt and john disingenuously post a completely one sided political diatribe built upon simple narratives like govt good, big pharma bad (zomg the french are happy! big pharma makes profits!) without doing even a single bit of the minimal back of the envelope analysis. Why would anybody believe you people?

  • JoAnne

    R in the first comment beat me to it.

    Healthcare is a topic that has become very near and dear to me. And while we do need to take care of the 50 million un- and underinsured, and while the health insurance folks are denying folks treatment (as they tried in my case with the MRI that diagnosed my cancer), there is no simple answer to this dilemma. It is a very complex situation!

    First point I want to make is that doctors everywhere are not the same. Quite frankly, I am alive today because I am fortunate to work for a university with an excellent medical school. If I had been insured by Kaiser-Permanente I am convinced I would be near death, if not dead, today. They would not have tried, much less approved, the extra step it took to detect my cancer. I spent the last year in a support group listening to women with complaint after complaint about Kaiser Permanente. BTW, whenever a woman in this group without health insurance was diagnosed with breast cancer, it was Stanford Medical Center, and not Kaiser Permanete, that would treat their disease.

    As to knowingly giving a patient futile treatments, I have also come to learn that there is essentially no such thing. We would like to believe that medical “science” is actually a science, but in fact, it is not. It is medical *practice,* more like an art than a science. Doctors don’t know (except in rare cases) when a patient will respond to a treatment and when they won’t. They apply treatments based on statistics, and sometimes the statistics are very poor (in the sense of small samples or being poorly executed). What human being could deny a fellow human treatment if there was a chance it could work.

    John, would you knowingly accept death if you were diagnosed now? Or would you rather stay alive, even if just a few more years, to be a father to Ian as he grows up? Sorry, in my book it’s just not as simple as you paint it. My cousin Margie’s goal was to stay alive until her sons graduated from high school. She didn’t make it, but nobody knew whether she would or not as her treatment was on the cutting edge.

    This is starting to ramble. I guess my bottom line, is that this is quite a difficult issue and that there are no easy fixes. And when our own lives, or our Mother’s and Father’s and Sister’s and Brother’s and Husband’s and Wive’s lives are at stake, we all want the best treatment possible. Sometimes it works, and doctors don’t know ahead of time when it will work and when it won’t.

  • Ellipsis

    I think perhaps the only thing that should come as a surprise to any readers of this post is that Kaiser is a nonprofit. Their actions certainly fool a lot of their clients….

  • http://etibb.com tacitus

    Well, glad, opponents of public healthcare certainly don’t seem to be all that keen on minimal back of the envelope analyses either, given that a cursory look at the amount spent on healthcare per capita in America is 50-100% more than in nations with public healthcare, with very little in the way of life-expectancy or infant mortality rate advantage to show for it.

    All I’ve seen so far are ads with scare stories that can easily be found under any system, including the private American system, along with the lies of prominent Republican politicians about what a public system would entail. (Hint: if you can afford private health insurance today, you will still be able to afford it even if a public system was created.)

    There are also the hidden costs of the current system in the US. Hundreds of thousands of American families have to declare bankruptcy each year at the very time when they are physically and emotionally least able to deal with the stress of unpayable bills. Millions more, without good insurance, constantly worry that their next visit to the doctor will reveal a problem they cannot afford to get fixed and lose them their job into the bargain.

    My family lives in the UK, and we have all used both the NHS (public system) and private insurance when the situation dictated. My parents are both alive today (at 80) due to timely and competent surgical intervention from NHS surgeons (heart disease and cancer), and didn’t have to worry one moment about raiding their retirement savings to pay for any of the treatment (which includes several permanent prescriptions).

    I used to have private health insurance through my UK employer, my brother-in-law runs a small business in England and has private health insurance because of the extra flexibility the cover affords him since he can’t be away from the business at the wrong time, and even my parents (not well off) opted for my mother to have a non-critical procedure done privately to avoid a six week wait. Post-op physio was available on the NHS, and so the private/public partnership that is possible in the UK worked very well for her and made the private option affordable.

    I have lived under both UK and US systems for more than a decade each. If you have a well paid job with excellent health benefits (like I did for 10 years) then the US system will work great for you, but that situation is getting harder to find as companies are less and less willing to shoulder the burden of their employees’ family’s healthcare costs.

    Since I quit my job, I had to shop for my own insurance. I went without for a few months, mostly through procrastination, I admit, but every little health concern began to scare the crap out of me, so I bought into a fairly decent plan — that promptly went up 20% after the first year, despite nothing but a couple of minor health issues that required nothing more than a doctor’s visit and a single prescription. So, after living without good company health benefits for the last four years, I can tell you that the additional stress and worry from battles with paper work, declined tests (after the fact), and more, I can categorically state that the NHS, with all it’s flaws, is becoming a very attractive proposition to me again. And I don’t even have a wife and kids to worry about.

  • http://etibb.com tacitus

    The term “non-profit” can be very misleading. You can be a non-profit and still heap multimillion dollar salaries on your board of directors, and other such largess. I don’t know what the situation is with Kaiser, but you have to dig a little deeper into their books to learn exactly how well they shepherd their customers’ insurance premiums.

  • Brent

    I’ve been reading this blog for a while for its interesting insights, but this post left me down. I also think that our (American) health care system is broken. However, I don’t see a path forward here, only logical fallacies. In the interest of brevity, I’ll only mention two:

    1) The poster draws a nonsensical connection between “for profit” and the results of less health care per dollar and more bureaucracy. These two outcomes only make sense for monopolies or mandated plans that have no competition. A free market solution that provides less healthcare would surely not be attractive to people who have the right to chose.

    2) “The right wing is fearful of rationing, long waiting times, or being unable to choose a doctor. The problem is that they simply don’t seem to give a hoot about the 50 million un(der)insured, who wait until they are terribly ill and then show up in ER’s. Guess who pays for that.”
    I don’t accept your dichotomy. Instituting rationing, wait times, and being unable to chose a doctor don’t magically solve un(der)insurance. Clearly, our goal should be somewhere in the complex middle ground (thanks JoAnne).

    I’m disappointed when people I would otherwise view as critical thinkers and pragmatists resort to ideological crutches which inhibit the public policy debate we should be having.

  • http://www.rosschurchley.com Ross

    According to Wolfram|Alpha, UnitedHealth Group’s total revenues sit at $81.19 billion – a bit under 700 times the salary you quoted for their previous CEO. Perhaps this is where her mystery number came from?

  • Vincent Archer

    @8: A free market solution that provides less healthcare would surely not be attractive to people who have the right to chose.

    That, of course, assumes that they have the finantial power to do so. Health care is expensive. That’s why you get 50 million people without proper healthcare. It’s not because there’s no free market, it’s because there’s little free market incentive to cover those people. Remember, the market swings both ways: Without an obligation to cover every citizen, health care companies can focus on the most profitable ones.

    (and you get your first piece of legislation for a freemarket healthcare: healthcare companies have to provide a set of fixed coverage plans, and are not allowed to refuse anyone who wants to subscribe one of these plans. They cannot revise their prices on your individual healthplan, and they cannot force you to change which healthplan you choose. They can only sever your coverage when you don’t pay)

  • Not an American

    > Access to quality health care should be a basic human right in a civilized, technologically advanced society like the US.

    Who said that you are civilized? You are rich and technologically advanced, but that’s it. Otherwise you are a barbarian, overly religious, warmongering, puritanic, racist society of obese stupid people.

  • Fred

    If you would like to help pressure Congress with your vote to pass single payer health care please join our voting bloc at:
    http://www.votingbloc.org/Health_Bloc.php

  • craig

    skip all the rhetoric and political position statements. health care in the US now costs well over 2 trillion (that’s a lot of zeros) dollars, all in. already is one payer – jane and john public. Either through payroll deductions, premiums or taxes (oh yes, that’s how a govt system is paid). So pick your poison. But it doesn’t lower the real issue – that 2 trillion dollars. and stop blaming the insurance companies. never saw a doc in my life driving a Ford. And btw, yes, we are a fat country – what was McDonald’s profits last quarter?

  • Matt

    For all the huffing and puffing, nobody here has actually addressed any of my points. “glad” argues that the military is different because “that’s arguably the central role of government.” But that’s not an argument, it’s just the statement of an axiom. He may or may not be a libertarian, but that’s just a statement of unquestioning libertarian ideology. The fact is that we spend half a trillion dollars each year on our highly professional and extremely competent military, which employs millions of people. For a very tiny fraction of that cost, we could also have a public health insurance option as well.

    Many other countries believe that maintaining the public health is also a central role of government. For some reason, we don’t, and our health statistics put us near the bottom of nearly every list. What we do now doesn’t work, and is far worse than what goes on in most other industrialized countries. Them’s the facts.

    And no, I never said that private insurance is worse than government insurance (although our Congresspeople and Senators seem pretty happy with it), any more than I said that public transportation was better than private, or that public school was better than private everywhere, or that public parcel services were better than private, or that public science financing is better than private, or that public television/radio was better than private (actually, in the last two cases, it’s probably true).

    This isn’t a “government is good, corporations are bad” argument I’m making, and the natural urge to box me into such labels is just a sign of the kind of partisan, ideological reflex that’s becoming endemic these days.

    What I am saying is that competition both within the private sector and between the public and private sectors is itself better for the people as a whole. And statistical evidence from countries with such public-private competition in the health-care sector bears out this claim.

    Right now, the private insurance industry has every incentive to increase health costs and deny coverage to patients. There’s no surprise that health care costs in this country are skyrocketing faster than in all other countries. If private insurers were competing not just among themselves, but also against a public program, then all of a sudden they’d have an actual incentive to lower costs and fight for customers. That’s one of the central purposes of competition in the first place.

    What’s funny is that a majority of health care expenses in this country are already paid by the public system. Over 50% of health care costs are borne by Medicare, Medicaid, and the VA system, because although they cover a minority of people with insurance, they have the lion’s share of the sickest patients, whom private insurers won’t accept. So our tax dollars are already covering over half of all health care costs right now. That’s the way things are already. And we’re getting a very raw deal for all that money because of the way things are set up in this country.

    The fact is that we can look around at other countries and see that most of them do far better than we do on almost every statistic. We can actually see other systems in practice. We have plenty of experimental data to examine. Some of these systems are better than others. It would behoove us to learn from their experiences and take the best from each, rather than sitting around and philosophizing or theorizing about the proper role of government, or sharing personal anecdotes rather than arguing over actual statistics and outcomes, naively believing the private insurers’ claims that they are telling us scare-stories for our own good.

    That’s just basic logic.

  • Scott

    My biggest concern is that once there’s a government health program, they will legislate health to lower costs. We’ve already seen that with the exhorbent taxes on cigarettes. What’s next? I understand that concern doesn’t outweigh the needs of those who can’t get insurance or can’t get coverage under their insurance. I just wish some restrictions on what the government could tax/ban were included in the legislation. As if that will happen though…

  • http://coherentstates.blogspot.com R

    Scott,

    This is probably diverging too much, but why is it bad to tax products proven to affect people? If there is a government health program, then the government should play a significant role in trying to stop people from becoming too sick. Sick people do represent a huge cost, not only on the medical side, but also a decreased productivity at work.

    Do you think private insurance companies do not “tax” you for smokers? Every time the insurance rates go up, it includes the cost of people that need intensive care because they smoked too much, or drank too much, or something too much. I even wonder how much insurance companies have to do with increasing taxes on cigarretes since having less smokers in the US that are still paying for insurance means higher profits for the insurance companies.

    You are concerned with the government doing that but you don’t seem to mind private insurance companies from doing that.

  • RD

    At its heart I see three problems.
    First in the last sixty years there has been a subtle change in attitude amongst the medical profession, from that of caregiver to that of a business entity. This change in sense of identity has an immediate consequence. When I see my doctor his primary calculation is not how to care for me but how to maximise his income, which influences his choice of procedure and treatment. Care becomes the secondary consideration. This, I would maintain is the primary force behind the huge growth in health costs.
    Secondly the entire professional community, medical and other has been subject to the societal forces of rapidly growing expectations.
    And this in turn leads to the third problem. The medical profession are in a uniquely powerful position to game the system, maximising their income and satisfying their outlandish expectations of growth in income.

  • http://coherentstates.blogspot.com R

    Agree with RD. I just wrote a post (http://coherentstates.blogspot.com/2009/05/healthcare-costs.html) on exactly those ideas.

  • Ja Muller

    Matt wrote
    “Right now, the private insurance industry has every incentive to increase health costs and deny coverage to patients.”

    This argument can be applied to everything. Every private industry has incentive to increase profits and decrease the cost of the good/service they provide to their customers. Unless you are advocating government to create a subsidized competitor in every industry, there is a big burden of proof on you to show that health care is different.

  • Sean

    “Government-sponsored single-payer healthcare, which succeeds admirably in many other countries around the world, is probably not a realistic possibility in the US.”

    In the real world, government-sponsored single-payer healthcare does not succeed so admirably. Come to Canada if you like and find out. *If* you have health insurance through your employer in the US (and since you work at a university I imagine you probably do), then it will be better than the government-supported system, and switching will be a huge downgrade. The government-sponsored system is only an upgrade for those who don’t have insurance already.

  • philip

    You should read “The Cost Conundrum” by Atul Gawande in this week’s (6/1/09) New Yorker.

  • Scott

    R, I wish I had a very good answer. It’s a conflict between my libertarian social feelings and my liberal financial leanings. Using the taxes on cigarettes was probably a bad option because I really don’t understand all of the reasons why states are putting them in place and increasing them. Obviously, the major incentive is to make more money. Outside of that, states claim that it saves X dollars on health care costs. I’m not sure if these are true costs of the government or if it’s cost of the private insurers who want to increase their profit margin. If it is the insurance companies drinking them (which would explain why both parties have no problem implementing this and other “sin taxes”, then my point is probably mute because our freedoms are screwed either way.

    I simply think that in a relatively free society that people should be able to willingly do things that are not in their best interest as long as it doesn’t physically hurt others or put others at significantly greater risk of injury. While I do understand that the costs of these activities are passed on to everyone in some way under any insurance system, I believe this is a valid tradeoff for such freedoms. Problem is, people tend to have little care about others’ freedoms when it costs them money. Once providing health care is a government responsibility, then the same people that create law now have added incentive to reduce costs in a way that upsets the least amount of voters. That will probably lead to further taxation of or simply outlawing unhealthy practices. Social engineering such as that is outside of the bounds of what I believe government is in place for. IMO, the government should educate, not enforce (and increased taxation is a form of forcing) personal lifestyle choices.

    I guess I don’t have much a point in the end. I’ve got two views that conflict in a method that can’t be argued other than limiting peoples’ freedoms is wrong and government health care will likely expedite it. It’s a bridge our government crossed long before I was born though. Few people have problems with the ever increasing number of things the government has done to protect us from ourselves, from smoking and alcohol taxes, to seat belt laws, to drug laws, to firework bans, to making suicide illegal (which I’ve always kind of snickered about). In this case thought, I definitely can’t say this concern should stand in the way of providing health care to all people and probably shouldn’t belong in a response to this post.

  • http://etibb.com tacitus

    Many other countries believe that maintaining the public health is also a central role of government.

    Just many? I can’t think of one modern industrialized western nation that doesn’t believe that. Switzerland was one of the last to join in, back in the 90s. Conservatives there were initially extremely hostile to the whole notion at first, but talk to them now and they don’t have a bad word to say against it.

    And that’s the crux of the issue for American conservatives. They know that wherever public healthcare is instituted, it’s there for good. Even in the darkest days of the British NHS, Margaret Thatcher, who privatized the vast majority of British nationalized industries didn’t dare to touch the NHS because there would have been an instant revolt amongst the voting public. Republican politicians and operatives are not scared of public healthcare per se, they are scared that it will herald a permanent political lurch to the left (a welcome move that would certainly bring it more into line with the rest of the developed world, IMO.)

    This argument can be applied to everything. Every private industry has incentive to increase profits and decrease the cost of the good/service they provide to their customers. Unless you are advocating government to create a subsidized competitor in every industry, there is a big burden of proof on you to show that health care is different.

    There is fundamental difference. Going without a TV or a new car is merely an minor inconvenience since there are plenty of cheaper alternatives available (or you can do without altogether). Going without healthcare insurance has a major risk of serious illness, bankruptcy, and death. Not only that, but the economy loses your productivity, and if you end up with bills you can’t afford, the costs of treating you fall upon the rest of us too.

    Also auto and household insurance have to be heavily regulated so that people can and will purchase affordable policies, because too many people going without becomes too great a financial risk to others when disaster strikes (e.g. accident victims and local governments, etc). For health insurance, if anything, it’s even more desirable for everyone to have some form of cover, especially if children are involved. Sick people are a major drain of resources in society, therefore it’s in everyone’s best interest that people be treated as soon as possible. Private health insurance is failing badly in that role for 50 million uninsured, and many more who don’t have the amount of cover they really need but can’t afford any more.

    In the real world, government-sponsored single-payer healthcare does not succeed so admirably. Come to Canada if you like and find out.

    Well first, nobody—not even the most left-wing of Democrats—is talking about single-payer, so it isn’t even on the table. Second, why do you think that the US government would want to adopt the worst system out there? Taiwan studied all of the public healthcare system out there before they adopted what they thought was the best pieces of the various systems in use around the world. The French system is the best in the world, and at least 30% cheaper than the American system—don’t you think Americans can do as well as or better than the French?

    The biggest threat to decent healthcare reform in America is that the lobbyists for the insurance companies will succeed in watering down the proposed legislation until it becomes utterly toothless and useless. We’ve see what the results are like when that happened in the financial services refoem. Do we really want see that happen in the healthcare industry too?

  • http://etibb.com tacitus

    Using the taxes on cigarettes was probably a bad option because I really don’t understand all of the reasons why states are putting them in place and increasing them. Obviously, the major incentive is to make more money.

    I believe the large hike recently ($1/pack) was to pay for the expanded SCHIP program covering children in low income households.

    Outside of that, states claim that it saves X dollars on health care costs. I’m not sure if these are true costs of the government or if it’s cost of the private insurers who want to increase their profit margin.

    There has to be some cost savings to government here. Smokers are disproportionately poor people, and they are the most likely to become a burden on the government for their healthcare since they cannot afford private insurance. If some smokers give up smoking from sticker shock, then that will reduce healthcare costs offsetting the tax revenue decline.

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  • John

    JoAnne, if I were diagnosed with a definitely incurable, terminal, condition, I would not request heroic futile measures. I want to live for many years to come, and if there is a treatment that could, with some reasonable probability, buy me more time, then yes, I’d take it.

    As you know, JoAnne, my mom died of lymphoma 11 years ago, at far too young an age. But what happened to her in her final weeks only increased her suffering, cost tens of thousands of dollars, and was done only because her husband would not let her die with dignity. She was clearly terminal. This happens all the time, and it’s simply irrational to spend huge amounts of money on tiny chances of survival. R, I just don’t find your comment #1 to be logical at all.

    Not and American: hey, we’re not so bad once you get to know us!

  • http://www.dentinmud.org Dennis Towne

    I disagree with a large majority of the proposed points. One of the most striking to me is the idea that health care is a ‘fundamental human right’. I see it as no more fundamental than the right to drive a car. This is strictly a personal opinion, as I see no fundamental ‘right to life’ either.

    Opinions aside, I think one of the biggest issues with our current health care system is that is it not nearly capitalistic enough. What we call a ‘free market’ health care system is at best a sham, and a major reason for this is the pricing differential afforded insurance companies over private individuals.

    Have you recently had, for example, blood tests performed? The difference between the billed rate, and the actual rate paid by my insurance company, is ten to one. (This is actual data from services performed at multiple locations in April, 2009.) The insurance company pays one tenth the price for the service that I would pay as a private individual without insurance.

    The problem is not that people cannot afford insurance. It is that they cannot afford not to have it! If I could be assured the same pricing (or nearly the same) as a health care company, I would have very cheap, extreme high deductible insurance and would pay out-of-pocket for most things. As it stands now, I cannot afford to do so, in spite of being responsible and reasonably well funded.

    To address this issue, I would propose that in the short term, legislation be enacted requiring services to be billed at the same (or nearly the same) rates for all parties. There is even some precedent for this type of legislation.

    Another major problem revolves around lawsuits. I honestly believe that the extent to which lawsuits are allowed in this field is excessive. Limitations on this and tort reform have been needed for years, though the odds of that occurring seem dismally remote. Part of the reason for this is the misguided notion that “you can’t put a price on the suffering caused by bad medical care”, to which the response seems to be “here’s a pile of money for your suffering”.

    Cannot we accept that doctors are human, that they will make mistakes, that modern medicine is a primitive crapshoot, and that yes, some people will die as a result? I find it unfortunate that doctors are penalized so harshly when bad luck comes their way (or to their patients.) Why are they hit so hard when traffic accidents that kill even more people are written off so easily as no-fault?

    Lastly, I strongly feel that the system is broken beyond repair. On the plus side, the system will become largely irrelevant in the coming century:

    1) Molecular research and other technological advancements will cure or reasonably treat most known diseases within the next two decades. Most cancers will be curable or manageable.

    2) Treatment prices will remain high for most of this time, but as we get the most common ailments and issues out of the way, pricing will drop like a rock in those areas. There will be plenty of edge cases and exceptions, but the vast majority of treatment will be for the primary causes and general maintenance. Consider the current cost of aspirin, general painkillers, and non-prescription drugs.

    3) With general issues easily and readily controlled and quick/easy diagnostic equipment available, health care will become more like performing maintenance on your teeth than a life threatening problem. Yes, you can ignore it until the pain becomes too great to bear or they cart you off on a stretcher, but short of something crazy happening even a crappy doctor or hospital will be able to patch you up.

    In a scenario like the above, health insurance becomes akin to comprehensive auto insurance and/or a warranty plan. You get it if you want it, but it’s really not that relevant if you don’t have it. It’s not like you’ll be bankrupted trying to pay for a cancer treatment or a flu shot. And only in this context will the health care system be fixed – by becoming a true commodity service.

  • http://coherentstates.blogspot.com R

    I just don’t find your comment #1 to be logical at all.

    Why not?

    What were the chances of finding the Higgs boson in the first experiment when it was considered possible to find it? I am not a particle physicist, but I would say not very high since some of those experiments have been around for several years and haven’t found it yet.

    What you are saying about not trying whatever ideas come to mind in medicine (even if futile), would be like not ever having tried the search of the Higgs boson in, say Fermilab. After all, a lot of money has gone into it and they haven’t found it yet. Some people might call it futile too.

    Just because you wouldn’t take a treatment that doesn’t have a reasonable probability of working (which by the way, what is reasonable?), doesn’t mean that the rest of the world thinks like you do. I bet a lot more people would spend that money in “futile” medical measures than in highly expensive physics experiments.

  • John

    R, there is a huge difference between doing research and day-to-day practice (to use JoAnne’s word). The aim of the former is to find out what works and what doesn’t, and you don’t do that on every patient that comes along. In scientific medicine, we adopt for routine practice those procedures which have proven efficacy. We should not spend hundreds of thousands of dollars on patients in their final weeks of life just on the off chance that they might miraculously recover.

    It’s a judgement call, and I think that by and large doctors do their best to inform their patients as to the realistic chances of success of the procedures that they do perform. And I believe that doctors only propose to patients and families options that have a reasonable chance. But doctors are bound to honor the wishes of their patients and their families, and no doubt err on the side of caution (and hope, however irrational).

    So the real question becomes: how much of the 27% of healthcare costs spent on the end of life could really be saved? My own wild guess is that it’s probably in the range of 5%, but who really knows?

    In the case of particle physics research, the outcome where there is no Higgs boson to be found is far more interesting than the outcome that we do find it. The fact that experiments have not yet found it is totally consistent with our best knowledge of its properties. See my earlier post on that: http://blogs.discovermagazine.com/cosmicvariance/2009/03/13/closing-in-on-the-higgs-boson/

  • http://etibb.com tacitus

    Dennis, America has by far the most capitalistic system of healthcare in the western industrialized world and is the only one that fails to cover all its citizens as a matter of course (until they drag themselves into the ER, at least). I really fail to see how even more of the same could solve all the problems inherent in the system.

    The “more capitalism” mantra is also a common refrain from conservatives as a solution for what ails the financial sector as they fight a rearguard action against tighter regulation that’s in the works. But, of course, that’s preposterous. High risk instruments like credit default swaps were the direct result of legislation pushed though by people like Phil Gramm to reduce regulation and oversight of the investment banks.

    We have many examples of public health care systems where the costs are much lower (up to 50% in many cases) and all citizens are provided with access. Some, like the French system, provide superior service at far lower costs than the American system. These are examples that exist today and can be studied in excruciating detail. On the other hand, there is no system that we can look to that is more capitalistic than here in the US and provides decent health care to all its citizens. Not one. So why on earth would we want to take a leap into the dark with another, even more, capitalistic system, when we have plenty of cheaper, effective examples involving some type of public system (and public/private) that have been around for decades?

    Seems to me that would choosing ideology over common sense.

    As for tort reform. There was a very interesting article in The New Yorker about MacAllen, TX, (The Cost Conundrum: What a Texas town can teach us about health care) which has the highest costs for health care per capita in the country. The interesting thing is that Texas restricts pain and suffering damages to $250,000, and the number of law suits has plummeted to near zero in the area, yet the costs are still soaring as doctors continue to use too many test and procedures on their patients. So, it appears that the threat of multi-million dollar laws suits is not as large an impact on costs as some claim.

    The worst problem in McAllen is obesity. That is an increasing problem all over the States, and if we can’t reverse the current trends, then it won’t matter what type of health care system we have.

  • Ellipsis

    Sean (not Carroll, I assume) wrote:

    > In the real world, government-sponsored single-payer healthcare does not
    > succeed so admirably. Come to Canada if you like and find out.

    I am a U.S. citizen who has lived in Canada for the past several years and the healthcare is far better. It is quicker to get a doctor’s appointment (next or even same day even for specialists) and no bureaucratic insurance hassles. There are many things that the U.S. is better at than Canada, but healthcare is not one of them.

  • coolstar

    Well, I’ve learned two things here: the French have a good health care system? Wow, who would have guessed?
    the second thing is “A typical doctor goes to school for a decade or more, endures years in residency and internships, and emerges a quarter of a million dollars in debt.”
    Of course that second thing is incorrect. MDs obviously go to school for considerably LESS time than it takes to get a Ph.D. in the sciences (as short as 3 years post-bachelors in some cases and 4 years more typically). Residency (do internships even exist anymore? I thought that was now just the term for the 1st year of a residency) hardly equates to being even a post-doc as it’s much more like being an assistant prof and, for a prestigious residency, perhaps more like being an associate prof. Quarter of a million dollars in debt? Try dividing by two and you’ll be closer to correct (med school costs in the U.S. track pretty closely with being an undergrad at an “elite” school, and yes, that IS ridiculous in both cases). Since the average yearly income for an MD in this country is at least $150K, that hardly seems like an onerous burden to me (wouldn’t be even if the $250K figure was correct).

  • Brian

    @Ellipsis,

    I agree, Sean seems to be on some sort of personal screed that has very little to do with the facts of the Canadian system. I know as I work in that system.

    No one in Canada thinks our system is perfect. We are regularly apprised by the media of the various failings of the health care providers. Let’s see, there’s a current hot story about the failings of Pathology lab results in Newfoundland and now Quebec. There were the recent problems with incorrect cleaning, and improper reuse, of medical equipment in Alberta. There’s a current suggestion that eHealth Ontario has been wasting money and cozying up with certain consultants. There are issues with waiting lists across the country.

    For all the flak it’s easy to miss the big picture. Canadians support the medical system here big time. There’s no way we would go back to the old ways, which looked very much like the American system. That’s not defensive that’s a plain fact. Support for private health care polls at roughly the same levels as any other fringe issue or group–it’s there, but just barely.

    The government health care system is regularly cited as a defining issue on what it means to be Canadian. Tommy Douglas, the real father of our system, was recently voted the greatest Canadian, EVER. We’ve had some good ones too.

    When the public system was introduced it faced all sorts of opposition. The usual suspects made the obvious arguments. In retrospect it’s clear that this was a scare campaign created by people with vested interests in the old system. Some were probably true believers who were simply wrong.

    So what does the system do right? Well, it’s expensive, but even acknowledging that, it’s far cheaper than the American system (roughly 9% of GDP versus 12%, last trustworthy figures I saw). On all proper measures the population health, life expectancy, care outcomes, are all easily as good as the American stats (and in line with all other developed nations).

    Let’s bring this home though. Canadians do not live in fear of ruined finances due to treatment. Acuity is lower on average because care is sought right away. The problems, though real, tend to get attention and resolution. As a government system health care is a political issue and it’s not good politics to let health care issues fester. The moral imperative to fix problems is unbelievably strong and opposition political parties exploit this to the max.

    Does the government try to intervene in people’s lives to reduce costs? Well, yes, sometimes, but the efforts are pretty weak and the more adventurous proposals invariably get shot down. The bottom line is that the system covers everyone. No one particularly wants the government getting too personal with their lives so the real interventionist stuff never goes anywhere. The latest twist is a tax credit for health club dues and the like.

    When you have a universal system, such rules would even apply to the politicos who would introduce them. That means that hypocritical positions, perhaps made for short-term gain, have little traction.

    No, I’m always amazed and humbled by the depth and breadth of citizen support for my industry in my country. We’re doing something right, make no mistake.

  • http://Interestingrelativityparadox uncle sam

    To the free-marketeers up there: private insurance won’t offer rates based on proportion of income, because the wealthy would pass up anything like that and underfund the system. To get insurance most people can afford, it has to be like Medicare: tax everyone a percent of income.

  • Brian137

    Dennis Towne says

    “I disagree with a large majority of the proposed points. One of the most striking to me is the idea that health care is a ‘fundamental human right’. I see it as no more fundamental than the right to drive a car. This is strictly a personal opinion, as I see no fundamental ‘right to life’ either.”

    Herein lies the first point of bifurcation. Some want our society to provide (excellent) health care for all who live here, and others do not, at least in so far as providing such health care competes with other goals. I make no judgement and I hope no implication about which side is right or wrong because I feel those labels are often quite arbitrary or even self-serving, but I also feel that what seems a discussion of tactics often masks a more fundamental difference of aims.

  • Brian137

    Brian and Ellipsis,

    Thanx for the inside perspective on health care in Canada.

    Yesterday I was Brian; tonight I am Brian137.

  • Brian137

    JoAnne,

    The last time I congratulated a woman about getting married, I was told that tradition dictates that I should congratulate the man. Not wanting to be gauche, I will simply wish you and your husband many years of life and huge, deep oceans of love and happiness.

  • Matt

    I can’t believe I’m actually hearing someone (“coolstar”) compare becoming a doctor to getting a PhD in the sciences. I’m a PhD student in the sciences, and I know plenty of doctors and med students. All I can say is, are you joking? Do you actually know any typical doctors? Do you know anybody going through the grueling process of becoming a doctor these days?

    Let’s see: 120 grand for undergrad, 120 grand for medical school. That’s a quarter million dollars right there. I haven’t even mentioned all the other life expenses, and the fact that you’re not making any significant income during all this time. It’s not like getting a PhD in the sciences: Few doctors get fellowships of any kind. It’s eight years of schooling, and then several more years in residency. And the high-stakes, no-sleep schedule young doctors have to endure in residency and for years and years afterward? These people don’t sleep. It’s crazy.

    As for salary, you really have no idea. Yes, doctors bring down a large gross. But being a doctor is astoundingly expensive. Unless you can find a group to pool costs or work at a hospital (and these have their own problems), you’ve got vast overhead, staff, and malpractice insurance to pay for; in some specialties, like obstetrics, malpractice insurance alone can run you $200,000 a year! Added to the fact that typical reimbursement from health insurance companies runs around 30% of what you bill, and even getting that much requires full-time staff members working the insurance company’s phone’s all day. A typical doctor in private practice basically has to add up all his or her costs for the day and then see enough patients to cover those costs. It’s insanity.

    Do you have any idea how long it takes a typical doctor to pay off their debts? Many never succeed in doing so. They just keep the debt cycle rolling year after year and pray they never get sick or injured and can’t work anymore.

    There was once a time when it was a lavish, high-flying lifestyle. Now it’s the hardest job on Earth, and with people these days blaming “greedy doctors” for all the problems of our medical system, it’s only getting worse.

    That’s a big reason why, like I said earlier, 80% of doctors in fields that deal directly with patients favor not just a public option, but a freakin’ single-payer plan. That’s a sea change from just fifteen years ago.

    It’s natural for many patients to vent their anger at doctors, because the doctors are the people they actually deal with face-to-face. Health insurance executives don’t have to deal with patients face-to-face. Lucky them.

    So every time I hear an entitled, overpaid insurance company executive put the blame on doctors (and, yes, they have the gall to do this, if you watch their interviews), I get a little furious. We may or not be able to live without health insurance company executives some day, and we may all survive it if they should someday all get driven out of business by a public option if the public option turns out to be superior, but we’re never going to be able to live without doctors. They have the most important job in the world. And it’s time people started treating them with a modicum of respect. They’re not your bloody servants. A good doctor will probably save your life some day, maybe more than once.

  • JoAnne

    Brian137: Thanks!

  • Joseph

    You wrote “Access to quality health care should be a basic human right in a civilized, technologically advanced society like the US.”

    You also wrote “Greater emphasis on counseling patients and families, plus a change in our culture that would make us more accepting of death, and an increased focus on preventative and palliative care rather than heroic but clearly futile and expensive late-stage treatments could save our society hundreds of billions of dollars per year.”

    Do the terminally ill not have basic human rights?

  • http://coherentstates.blogspot.com R

    there is a huge difference between doing research and day-to-day practice

    That is your point of view, and while valid, it is not necessarily true for everyone else. As a scientist I believe research is important, very important. But there is also some, mmm… I guess arrogance, or at least disconnect from the world we live in, when someone is OK with spending tons of money in physics, for example, but sees a problem with trying everything to save a human life, or at least to make that person’s last days more “comfortable”.

    And I believe that doctors only propose to patients and families options that have a reasonable chance

    So, some patients or their families know so much as to propose procedures that are very expensive? If any, the doctors are proposing such ideas to get more money, you can always justify them by arguing you were trying to save a life. If this is the case, then I agree with you, they should be something done to prevent this, but if this is indeed the case, the problem are not the patients but the doctors.

    In the case of particle physics research, the outcome where there is no Higgs boson to be found is far more interesting than the outcome that we do find it.

    While true, this is not the point. My point was that millions of dollars have and probably will continue to be spent on finding the Higgs boson. If it is not found, what prevents people from calling those measures taken “futile”?

  • http://www.healthcaretownhall.com Jeremy Engdahl-Johnson

    The proposed 1.5% cost trend deceleration is an interesting number. We put the number in perspective–in the context of costs for American families–at http://www.healthcaretownhall.com/?p=914.

  • chemicalscum

    In the real world, hat is outside the USA a universal public healthcare is regarded as the principal criteria of civilization. Therefore the world does not regard the USA as a civilized nation (there are other reasons for this as well, Iraq anyone). Obama has the chance to change this. Whether or not he will is anyone’s guess. Still he is a likeable guy unlike his predecessor eh?

    As a proud Canadian, yes our health system may have its weaknesses, but overall it’s outcomes are far better than in the US. There has been over the last couple of decade a publicity campaign against it in the media here that has been organized by US health companies trying to get a foothold to rip off the Canadian people the same way they have done to USians. Canadians have seen through it and strongly support our healthcare system.

  • John

    R: The term “palliative care” means making someone’s final days more comfortable. I certainly have no problem with that. Everyone should have access to that, don’t you agree?

    If we don’t find the Higgs boson we will have learned something very important. In 1886, Michelson and Morley failed to find the ether. Was that “futile” ? Should they not have been funded to do that experiment because the ether was not there? Your line of argument made no sense in the beginning, and it still makes no sense. I think you need to do some reading, frankly. Not just about the Higgs boson but about how science moves forward.

    I really don’t think doctors propose expensive procedures just to make money for themselves or the hospital or whatever. At least, I don’t want to believe that, because it’s really sick. But I *know* from first-hand experience that futile procedures are performed, every day, to make the patients and/or families feel like they tried “everything they could.” It is obviously a very difficult judgement call, where to draw the line. And I would rather that doctors, in consultation with patients and families, drew it, not health insurers, the government, or anyone else. If more people were more realistic and informed about the realities of their situation or that of their loved ones, more people could die, peacefully, in dignity, with fewer holes in their bodies with tubes coming out, frankly. And we would, yes, save a huge amount of money as a society.

  • http://coherentstates.blogspot.com R

    John,

    I think you think you are so sure that your ideas are correct that you either failed to see my point, or avoid it purposely. I picked particle physics because that is one area that people are somewhat familiar with (not with the science, but the idea. For example, I am sure many people now have heard about the LHC) and where large, expensive experiments are done. I never said that we shouldn’t look for the Higgs boson, in fact, in my first post I said that not looking for it was wrong. It was just an example of trying something without being 100% sure it will work. Should we do it? Of course, but also in medicine.

    My point all along has been that it is wrong for you to decide that doctors should stop performing procedures that will, supposedly have no good purpose. Just as an example, not that long ago, a young girl got bitten by a rabid animal (if you want the link I can find it for you) and didn’t go to the doctor soon enough. She showed up to the hospital with symptoms already. Everybody “knows” that once the symptoms of rabies develop you will die, and they weren’t going to try anything on her. However, one doctor suggested a very expensive procedure, which among other things involved inducing a comma and of course have her intubated and what not in the ICU. If what you suggest had been done, she would be death. Luckily, the doctor, and the family, didn’t think like you do, and she is now alive and recovered. They think she got a not so aggressive rabies virus, but they didn’t know that at that time. You seem to be focusing on cancer, which in many cases it might be true that even with whatever you do the person will die, unless you are 100% certain that going for “futile” procedures will never work, or think that saving, even one, life is not important enough then you should think better before you write ideas like the one on this post. If those procedures didn’t work for you, then I am sorry, but that doesn’t mean that they don’t work for other people.

  • Mike

    I read your post, John. I read all the comments, including your replies to comments. Others here have responded in gentle ways to your views on saving lives. I thank them for doing that because they blunted some of the anger that would have crept into a reply of mine to your post. Your views put me off so much I won’t read another one of your posts.

  • JoAnne

    Being a cancer patient myself, I think the notion that John writes about of “people could die, peacefully, in dignity, with fewer holes in their bodies with tubes coming out” says actually more about the people watching their loved ones than about the patient themselves. I’ve actually been the patient (as well as having experience with being the one watching) and I know the line where the patient could really care less about tubes and dignity, is crossed very, very early on. Well before anyone watching realizes it. (In fact, one could argue that all dignity is lost just by doning the hospital gown.) I truly think the BS about tubes and dignity is all about the people watching, and the cancer patient themself is actually glad that doctors are doing *all* they can. I wouldn’t ever want a doctor to give up on me.

  • Haelfix

    John has a point frankly.

    Medical science is a bit like particle physics. As technology improves, the costs continue to go up, and apparently there is no ceiling to how high it can go.

    Its rapidly reaching a point where we will start having to really ask ourselves some hard questions, regardless if the system is public or private.

    Questions like: Is it really that “moral” to spend 10 million+ dollars of public taxpayer money on treatment that prolongs life by a few months? Really? You could take those funds, send it to Africa and keep a hundred people alive for decades.. Cost/benefit analysis is not even close. Like it or not, money is limited and ultimately human life and health does have some sort of effective dollar value. It sounds callous, but it is true.

    I’d also like for the system to be graded as well. It makes perfect sense to me that someone who doesn’t smoke, eats healthily and exercises should pay substantially less than someone who is overweight and a drug, nicotine and alcohol abuser. I don’t particularly relish the idea of paying twice as much for a society that insists on destroying itself.

  • Mike

    Haelfix Says:
    “Is it really that “moral” to spend 10 million+ dollars of public taxpayer money on treatment that prolongs life by a few months? Really? You could take those funds, send it to Africa and keep a hundred people alive for decades.. Cost/benefit analysis is not even close. Like it or not, money is limited and ultimately human life and health does have some sort of effective dollar value. It sounds callous, but it is true.”

    Is it really “moral” to spend the equivalent of 6 billion US dollars on the LHC when you could take those funds, send them to Africa and keep thousands of people alive for decades. It may seem callous to physicists, but all of them probably could get jobs in other fields, or perhaps go to Africa and manage/distribute the money. Cost/benefit analysis is not even close.

    Then there are the billions of US dollars people want to spend on going back to the moon– or on going to Mars………….

  • John

    I think it makes us all very uncomfortable to be pushed to equate saving or extending lives with money. How can one place a value on a human life, or one person’s chances over another? But the fact of the matter is that we face these decisions and calculations all the time. Who do you want doing that, doctors and patients, or insurance companies? Should the outcome be judged by how much profit is made, or by how many lives are actually saved or extended?

    R, I think I see what you are trying to say, but I guess I don’t find the analogy that strong or relevant. There is a big difference between research and daily practice of what we’ve learned. We have, in physics, already hit the limitations that high costs impose – otherwise we would be constructing the International Linear Collider by now – that’s the ultimate machine to study the Higgs boson. But its $20 billion price tag has put it out of our reach, even though we know it would work (if the Higgs is there!)

    Mike, I am sorry if any of my replies to comments seemed less than gentle or humane. Like all of us (I hope) I am just trying to imagine a future where the 50 million uninsured can have the same access to the great health care that saved JoAnne’s life. It really is a complex issue, and emotions obviously run high, but I hope you can believe that my heart is in the right place even if you don’t see eye-to-eye with my particular views.

  • Haelfix

    You know, having grown up in a socialized system in Europe its rarely mentioned but the cost/benefit analysis is very much a part of the system.

    If you are past a certain ‘prime’ age, you can be denied various expensive treatments. So, if you want that PET scan, and you have cancer and past the age of 80 or so, there is an equation somewhere that tells you if you are eligible or not. So both callous and reality.

    Ultimately healthcare as currently formulated, is a ponzi scheme. One could easily imagine a future where we are all over 100, and require extensive organ replacements sucking up more and more GDP and more and more young workers fronting the bill for an increasingly aging populace.

  • http://catquibbles.blogspot.com serial catowner

    It should come as no surprise that Medicare spends a large proportion on the last year of life. Medicare covers the elderly and the disabled. The healthy young people are not in Medicare’s pool.

    Then, of course, there is the question of how you know it is the last year of life. When an 82-year-old breaks their hip, it hardly seems fair to say “Well, your time is up- prepare to meet your maker”. Most 82-year-olds will recover quite well with a hip repair. And this is the reality of “spending on the last year of life”. People like to imagine it is useless spending to extend an almost corpse-like existence a few hours more, but in reality many people are up and enjoying life but needing more health care than 20-year-olds who literally bounce off the pavement when they fall. Of course it cost more for their 83rd year of life than it did for their 20th! What did you expect?

    This whole canard should be put to rest under the observation that we all will have a last year, and day, and hour, and the things that are done in those ‘last’ moments will be things that are done for many other people and work well to extend life. The whole statistical set is biased by looking at it through a polarized filter.

  • Mike

    John wrote:
    “I am just trying to imagine a future where the 50 million uninsured can have the same access to the great health care” and “I hope you can believe that my heart is in the right place even if you don’t see eye-to-eye with my particular views.”

    You wrote about the costs of saving peoples’ lives. I said nothing pro or con about extending health-care to the 50 million uninsured. Don’t “include” that issue with what I said about your views on saving peoples lives.

    I don’t see eye-to-eye with your views on people who have Medicare, etc., types of insurance and are making the decision to use it when faced with their own death. You seemed to be against it and came across to me as if you were saying: “Aw, come on people, just get over it and die. Then we could have national health insurance with the money we’ll save.” And you wrote we need to make “a change in our culture that would make us more accepting of death”. Yeah, just do that.

    You offer wild guesses (your own words) on how much of of the 27% of health-care costs spent on end of life can really be saved. You choose 5% and then later on in the blog seem equate that to saving hundreds of billions of dollars for society. Where did the 27% come from? One-twentieth of that is hundreds of billions of dollars? Or 22% of costs will still be end of life and 5% will be saved?

    When faced with death I don’t think many of us can be as strong as you are.

  • Low Math, Meekly Interacting

    Not to state any position one way or another, but I thought my local public radio station had an excellent series on End-of-Life medicine in the USA. It might be of interest:

    http://commonhealth.wbur.org/wbur-posts-and-stories/2009/04/quality-of-death-end-of-life-care-in-america/

  • John

    I have been having trouble submitting comments, so I’ll try again.

    Mike, I don’t think you can disentangle end-of-life healthcare costs from insuring the uninsured. Everything needs to be in the mix – it is very complex. I never said “Aw, come on people, just get over it and die” which is truly cold. But Americans hate the idea of dying, it’s a taboo subject (as we see here) to discuss, and certainly no one wants to be told when and how to do so.

    Serial catowner, you made some very good points: just what is the total expenditure on end-of-life, not just Medicare. It’s admittedly an old study (1992-1996):

    “Last year of life expenses constituted 22% of all medical, 26% of Medicare, 18% of all non-Medicare expenditures and 25% of Medicaid expenditures.”

    Expenditure in the last year of life might not be the right statistic, but it’s widely available.

    And here is an interesting take on the subject: http://www.governing.com/articles/0904healthmyths.htm

    They claim that even if we were to eliminate futile treatments it would only represent 3.3% of total health care costs (not so far from my wild guess) and that it’s a “one time savings” which I don’t completely agree with. Viewed that way, any savings from changes in policy or practice are “one time savings”.

    Since the total US healthcare costs are now over $2.4 billion, if we could somehow save that 3.3% it is $80 billion a year.

    I think we should repair 82-year-old broken hips, in general, yes.

  • http://lablemminglounge.blogspot.com/ Lab Lemming

    “So was Elizabeth Edwards wrong? Turns out, she might have been referring to UnitedHealth’s former CEO, Willim McGuire”

    Or she might have just been pulling numbers out of her ass.

  • http://www.reallymagazine.com Martin g

    ” one of every $700 that was spent in this country on health care went to pay him.” Ermmmm . . . that doesn’t sound too bad . . . so he’s made $700 then ?

  • bigjohn756

    Do you really expect our government, or any other government for that matter, to run anything more efficiently than private businesses? Please, show me one instance of this happening. So far, nothing I have seen that the government has done can begin to compare to commercial operations. As far as I can see, y’all are only concerned that some people in the private sector will get some of our money instead of our government. Success must be punished. Can’t have anyone making a profit from their efforts when your uncles and cousins can get something for free instead.

  • Brian137

    58. bigjohn756 Says:
    June 2nd, 2009 at 3:35 pm
    <<<>>>

    The police, fire departments, military, and public universities come to mind as examples of reasonably well-run government institutions. NASA has had a few successes too along with some missteps. Public and private entities both draw upon the same pool of participants: people. People are by turns both endearing and frustrating.

    <<<>>>

    I own a business and would never advocate any punishment that I, myself, might have to share in.

    <<<>>>

    Surely, the world has worse problems than gluts of people getting too much for free.
    Title for horror movie: “Attack of the Freebies.”

  • http://www.doctors-4u.ca/ Ontario Health Watcher

    Open Source EHRs are free to work with — OpenEMR is one, MirrorMed is another. They are free to use, have upgrades that are being shared by many, and will continue to be dynamically growing. And they have the best shot of being truly interoperable over the long term. And yet I haven’t heard a word about it around them in this story. Why not? THAT is the real scandal in my mind!

  • http://www.doctors-4u.ca Dr. Ontario

    I don’t understand the overlying issue here. So it costs money to bring in the best consultants in Canada who have been successful installing eheath records elsewhere. That’s a shock? That’s a scandal?

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