On one hand Americans are obsessed with the cost and availability of healthcare.
On the other they have a great fear of rationing / using health dollars wisely.
My FB Friend pointed me to this fascinating piece. Below are related links, and I threw in the obesity one to remind folks that comparing America to other countries is not as straight forward as looking at the numbers alone. We are a very different culture...
Other Links...
OECD Doc: Americans are Tubby
G2A American Healthcare Cost Drivers
Peterson Infographic
Common Wealth Review
Atlantic How We Spent $3.4 Trillion
HBR Seriously Ill Patients
On the other they have a great fear of rationing / using health dollars wisely.
My FB Friend pointed me to this fascinating piece. Below are related links, and I threw in the obesity one to remind folks that comparing America to other countries is not as straight forward as looking at the numbers alone. We are a very different culture...
Other Links...
OECD Doc: Americans are Tubby
G2A American Healthcare Cost Drivers
Peterson Infographic
Common Wealth Review
Atlantic How We Spent $3.4 Trillion
HBR Seriously Ill Patients
From HBR... "One-quarter of all Medicare dollars are spent on treatment during the final year of life, with one-third of the final-year expenditures squeezed into the last month before death. Over that period, 80% of spending is for hospital-based treatment, much of it in intensive care units (ICUs). America’s medical model has mastered trauma, infections, and other curable conditions — but it fails when it’s applied to advanced chronic illnesses."Thoughts?
39 comments:
Trump promised that we would receive better care at lower prices. The most immediate thing they could do would be to use the market power of the federal government to push drug prices down, something Trump was very clear on wanting to do.
I'm waiting.
--Hiram
"Soylent green is..."
Jerry, You are the big fan of small government. Why would you want Medicare to spend a huge amount of money on 80+ year old citizens?
Especially if it does not improve their quality of life.
And if they are too poor to get that service else where... Wouldn't you usually say they should go to a charity for care?
I guess it only makes sense that most of one's medical costs are racked up close to your death. After all, if you're not seriously ill, you're probably not using up tons of health care dollars. It seems we need to be able to accurately determine when people are going to die, so we know when to cut off their health care.
Well, Medicare "cut off" my Father's health care and he died. Do you really want government deciding when people die? Soylent green is ....
Sean,
Did you read the article... Auto defibrillators installed in old people who have a Do Not Resuscitate order. Come now.
Jerry, As usual, I know you blame Medicare for your Father's untimely demise... But I still can not find a law that prevents hospitals from extending a stay if the customer is willing to pay out of pocket.
KFF Medicare and End of Life
Medicare Hospice Care
Medicare End of Care Appeal
Types of Providers
NYT Premature Discharge
"The process is similar for appeals from other types of facilities, including skilled nursing, home health, rehabilitation and hospice services. In each case, you should receive a notice two days in advance advising you that services are set to be terminated and letting you know how soon an appeal should be filed. Again, you cannot be forcibly discharged while an appeal is under way; decisions regarding these services are rendered 72 hours after an appeal request. For home health care, a letter from a physician stating that this patient continues to needs services is also required.
What is different are timelines for these appeals. You will need to challenge a proposed discharge from a nursing home or home health care before noon of the day before the planned discharge date, according to Nancy Borgstadt, director of review services for CFMC, the Q.I.O in Colorado.
But if your appeal is denied and the original discharge date is upheld, you will have to pay the cost of the extra time you spent in home health care, rehabilitation, hospice or the nursing home out of your own pocket, which can be considerable."
I was told none of this, of course, and likewise have been unable to find even what you did. But it is exactly as I have described the conversation.
My point is that government apparently, fair or not, legal or not, terminated my father's life prematurely and I do not want that becoming commonplace. I know it is "unfair" that those who can afford to live longer do, but neither is it fair that some must die before their time in the name of fairness.
Jerry,
I empathize with you, the strange situation you have shared with us was very unfortunate.
Just as I empathize with poor people who can afford only minimal care... The same ones that you would send to the emergency room and stretched charities...
I point out that we are discussing "end-of-life care" and in this country everybody, rich and poor, gets Medicare. And that is perfectly fair because those who can afford better care to extend their lives are denied it by the government.
You keep saying that... But provide no proof... Remember my quote above.
"But if your appeal is denied and the original discharge date is upheld, you will have to pay the cost of the extra time you spent in home health care, rehabilitation, hospice or the nursing home out of your own pocket, which can be considerable.""
my proof is my personal experience. can you prove that this regulation is followed in every case?
Jerry,
Since it was a very emotional experience and your very rigid personality / beliefs may have contributed to the problem... We will need a better source.
How about simple logic? If government pays for and therefore decides who gets care and how much, what is the possibility that people are free to make their own decisions on the matter?
100% if they have money and the desire to spend it...
My personal insurance policy comes with many limitations, rules, procedures, etc.
Medicare has the same of course.
Forbes Does Not Accept Medicare
KHN Slowdown Discharge
Medicare Advocacy
Facilties Accepting Medicare Can Not Charge More
"Auto defibrillators installed in old people who have a Do Not Resuscitate order. Come now."
Sure, you can always find an example of things going wrong. (Was the ER that treated this lady ware of the DNR?) The reality is, as I stated though, that you're going to encounter most of your medical expenses near the end of the road even with perfect medical selections. That's just the way it works.
Sean,
I agree however it is worth discussion.
How do we as a society in a modern world when life can be prolonged through incredibly expensive treatments decide where to spend a limited amount of funding?
Conservatives belief that people with money should get whatever services they want while the poor should be at the mercy of charities.
Liberals seem to think something different. Maybe that the poor should get lots of someone else's money no matter how they chose to live their lives.
"How do we as a society ... decide..."
There's your problem, right there.
What problem is that?
Our society decides our property rights and protects those rights.
Without our society the strongest could prey on the weak and take what they want.
We decide how to keep our society peaceful, hopeful and productive.
Conservatives fascinate me when they want all the benefits of our society...
While balking at the responsibilities and communally decided controls.
Now wait a minute. Who is responsible for your health care? Me? Vice versa? Why is my health care a "benefit of society"? Was the pizza I had for dinner a "benefit of society or did I buy it for myself? I thought you were big on PERSONAL responsibility, not to the collective.
Is your personal wealth and long term stability of value to you?
In an anarchist society, would you have your wealth and stability?
Please remember that a lot of people in Syria were living a happy, healthy, well to do and stable existence until their society collapsed...
Next thing they know, they are homeless and hungry.
Now I know that you like to claim that you are an island and owe nothing to anyone...
But we all know that is not really true.
Is there some reason a civilized society must be a socialist autocracy? What is wrong with personal liberty and responsibility as the basis?
I owe to others what I choose to give to them, and not what government would compel me to "freely give." Forced charity isn't charity.
No socialist autocracy required...
Just a democratic government that works to balance personal freedoms against social goals to keep our country stable and secure.
Forced "donations" to our society are the price we pay to be part of that society...
The same society that enables us to learn, work, save, invest and live in peace.
I bet those folks that live, lived or died in Syria wish all they had to worry about was their tax rate, and who that money was helping.
This conversation began with asking "who decides" whether Gran-gran could get that operation or not. I claim it a personal right to make that decision; you claim the government or "society" gets to weigh in. Right?
Actually it started with me asking one question. "Thoughts?"
As for "weighing in"... Of course the "insurance company" who is paying for the procedure gets to weigh in whether it is covered under the applicable policy.
Now if the Gran-gran is wealthy, based on my research she is free to have the procedure if she wishes to pay for it out of pocket.
so, since the "insurance company" for the elderly is the federal government and Medicare, are you okay with them telling poor people they have to die?
I am not telling them to die... I am taking a page from your play book.
"They can just go to the emergency room, beg for charity, beg their family members, etc."
Does that sound familiar?
Not in the least. Even the words you put into my mouth, however, are consistent with the individual CHOOSING their course of action, restricted only by what other individuals/groups/institutions are willing and able to do for them. It is not a government "death panel" making the decision.
No death panel required...
If you run out of benefits... You just have to start begging those other individuals, groups & institutions ...
Same answer that you give to other poor people.
The difference is that you are begging for care, or for money to buy care, rather than PERMISSION to go on living.
Nobody here is recommending forced euthanasia...
Not sure what you are thinking?
I'm not worried about you. I'm worried about "society." You seem to believe "we" have such a right, even an obligation, to end individual life.
Again... Where are you reading this in the comments above?
Does your reluctance to support universal tax payer supported health care mean that you "believe "we" have such a right, even an obligation, to end individual life."?
"Why would you want Medicare to spend a huge amount of money on 80+ year old citizens? ... Especially if it does not improve their quality of life." -- John
Why would you want some government bureaucrat and rules to tell you what your quality of life was, and whether money spent was "worth it" to THEM and not to you? Suppose you needed a heart bypass, and you were 81 years old. Is that the time government should decide they won't pay for it? Why or why not?
First, that was a question... Not a policy statement.
Since it is a public program, paid for with public dollars and it is in financial trouble in part because we work miracles when the money is there... Extending lives and incurring more costs...
I mean should Granny be able to have her hip replaced with your tax dollars? Or should we buy her a cane?
Now if the woman was 40 years old and poor, I assume you would hand her the cane and tell her to be thankful for that.
You are happy to withhold tax dollars from younger unhealthy people.
What makes you view older people differently?
As this conversation began, it was about old people, and you argue for treating them differently simply because they are old and need more medical care than the young and healthy. The question is why these young and healthy should INvoluntarily pay for the medical needs of the elderly? Or NOT be allowed to contribute voluntarily to that care? Or not be allowed to have an HSA that would allow them to pay for their own elder care and not depend on a penny-pinching government?
Medicare is going broke. It isn't working. Is the solution to ration care, increase taxes, or move away from a government-run model in favor of individual freedom and the free market?
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