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.

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.

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.

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………….

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.

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.

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.

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.