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.

< <<<"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.">>>>

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

< <<<"Can’t have anyone making a profit from their efforts when your uncles and cousins can get something for free instead.">>>>

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

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

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

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.

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.