An uncomfortable truth

There are a lot of people who think that the free market is the holy grail for any issue that plagues society.

When it comes to health care, we have tried the free market and at the very least we have come to the conclusion that the free market does not work perfectly for health care because it is a relatively inelastic commodity.

One of the focal points of the current administration is the high deductible health plan. Under this plan, your preventative care is generally covered and you have a very high deductible. You also get a health savings account (and if your employer subsidizes your insurance premiums, you may end up with more in your health savings account than you pay in premiums (you can withdraw this amount after you retire like a traditional IRA more or less). The theory is that you will be a more discriminating consumer of health care services if you have a more direct stake in the costs. Once again this assumes that health care is elastic and that the current system encourages us to consume more health care services than we really need. It may be true that we are consuming more health care services than we need but until you are terminally ill you do not consume enough excess health care to make a big difference.

This brings me to my main point: You consume over 50% of your health care costs in your last 2 weeks of your life. If we decided that terminally ill people who have lost consciousness with no statistically reasonable chance of regaining lucid consciousness before death should be just allowed to pass, we would not have a health care crisis. Its an uncomfortable truth but our health care crisis (a far larger crisis than our social security crisis) would disappear if we allowed people to pass naturally instead of hooking them up to every new invention under the sun.

This leads me to my second point: high deductible health plans cherrypick the population. Historically, the young, single, healthy population of a health plan has subsidized the older, married or sicker members of the health plan. HDHP is a very attractive option for a young, single, healthy person and this leaves all the historically subsidized groups incurring historically high costs.

SO WHAT? Well, those older workers paid higher health costs then they imposed on the system and effectively subsidized all the older workers before them; those married parents subsidized the married parents when they were single; at some point before they got sick, many of those those sick people susidized those who were sick before them.

I am young and healthy so HDHPs work out well for me but health insurance should be part of the social contract (thats right I said it UNIVERSAL HEALTH CARE, it had to be said) and one of the terms of that contract should be that when you are terminally ill, unconsious with no statistical possibility of regaining consciousness, we will just let you pass naturally without hooking you up to a million machines. With this small but uncomfortable change in how we do things, we would not have a health care problem.


Anectdotal: My mother died of liver cancer, slowly, over a course of two years. Don’t have any figures, but I’m sure the last two weeks – spent at home under care of Hospice, my brother and aunts, and me – and coming after all the surgery and hospital stays – cost practically nothing apart from the prescription meds.

The factoid I’ve heard isn’t the last two weeks, but rather the last year, the last year of life consumes 50% of the health care dollars. That’s what “they” say, anyway. And you know how trustworthy “they” are.

That’s what I’ve heard, too. Maybe it was 6 months instead of a year, but no way it’s 2 weeks.

What difference does it make if it;s a week or a year. The OP still makes a good point about how much money is wasted on end-of-life care and pointless, expensive attempts to keep lost causes alive artifically instead of just letting them die naturally like they’re supposed to.

Well, the obvious flaw with your plan is that you can’t really tell when the last year/month/week of your life is until after you’ve carked it. But apart from that, yes. I do think theres this unhealthy obsession with the preservation of life at all costs rather than focusing on judicious use of our resources. It’s an easy position to take because you can demonise the other side as being morbid and monsterous.

Many times we keep people alive beyond the point they wish to live. Case in point: my mother. She was in the hospital for the procedure to clean out the carotid artery. A stroke is a known complication of this procedure, and both mother and I knew it. She had signed a consent form for the procedure and had signed a DNR order - if she had a stroke she did not wish extrordinary measures taken to keep her alive.

The surgery went well, she back in her room, I went home. They called me in the middle of the night to tell me she had a stroke. When I got to the hospital, she was on a respirator. WTF? Because she was out of the recovery room when she had the stroke, the DNR order did not apply, even though the stroke was the result of the surgery. She ended up living six very miserable, painful months in a nursing home. We are kinder to our pets.

Another reason doctors keep patients alive at all costs is because they are afraid they will be sued if they don’t.

Who decides end-of-life deontic issues? Of course, given that it is truly a lost cause and the patient is unconscious it is truly a drain on society’s resources, but in fact we rarely know for certain and the patient is usually lucid.

Furthermore, what’s to say that the saved resources would be put to good use rather than spent on metaphoric hookers and blow? It would be one thing to prioritize preventive care and early intervention surgery, but to a certain extent resources are fungible.

If the patient is conscious and willing to extend life-prolonging treatment, the issue is their analysis of their chances of recovery, their comfort and pain during that time, and their own choices about spending resources.

When did that happen?

Not lately, obviously – the artificial tie between health insurance and one’s employer, driven by government policy, has been in place in the US since WWII.

:confused: Please explain. I know of no government requirement for coverage. (Unfortunately.)

My m-i-l broke her hip and shoulder at 88. We thought that was it, but an expensive operation made her much better. She died two years later of pneumonia, quickly and relatively inexpensively. I agree with Shalmanese - you don’t know if an expensive operation will or won’t work in some cases. If we had a life meter like in the Heinlein story, we could do much better.

As for the OP (and I think he’d agree with this) the problem with the Health Care Accounts is that they are not all that useful for people with low income who can’t afford to stash away lots of money every year to cover the high deductible. These people don’t get that much of a tax break either. I use one, that lets me save money tax free to pay for medical costs not covered by insurance, but there is a relatively low limit (about $2000 a year) and it goes away if I don’t use it for the year (no worries there.) This works great for me, but it is far from a solution to the healthcare crisis.

Said artifical tie is probably the fact that income tax laws are structured in such a way that employer-provided insurance is paid for from pre-tax earnings. This is a large financial incentive to have employer-provided health insurance for both sides of the equation–the workers get more net pay after insurance/taxes than otherwise, and the employer gets to provide said net pay at less cost to themselves.

I think part of the problem is that the American mindset puts life “for the sake of life” ahead of quality of life. We collectively feel that any sign of a heart still beating equals something positive. Until people believe that life is more than blood flowing through one’s veins, I’m afraid we will continue along the path we’re currently on.

With regard to people over-using healthcare benefits, I’ve learned a lesson via my in-laws that really opened my eyes. You can be refused private healthcare benefits for something as simple as going to the doctor for a strained back. Happened to my SIL. Insurance companies consider many simple problems to be red flags, and therefore, will not pick you up. Something to think about next time you run to the doctor with a relatively minor problem. It can put a monkey wrench in your early retirement plans.

I do not think the resources are fungible when we talk about the health care crisis. We are talking about medicare dollars specifically and the general cost of insurance.

My main point is that we waste too many (non-fungible) health care dollars. An auxiliary point is that too many people these days think that economic principles and the free market mechanism can be used to solve all our problems. This administration buys into it, which by itself wouldn’t be a problem if they didn’t use speculative economic theories. Privatize social security, promotion of HDHP insurance, tax cuts, repeal the estate tax, school vouchers, etc. This doesn’t mean that none of these be used to improve the status quo but none of these work in the form presented by this administration.

If the theory of evolution and the theory of global warming are not sound enough that we can base our public policy on them, how in the world is supply sided economics (trickle down theory) or the Bush Doctrine solid enough to bet our futures on?

IIRC There wasn’t a requirement for coverage but a cap on salaries, making fringe benefits, such as insurance, the defacto way of ‘paying’ someone more for a job.

And just to add another seemingly relevant anecdote - My great-aunt is over 80 yrs old, has alzheimers, emphazema, and just went through her 2nd hip replacement about a month ago. When they had her on meds, she was at the brink of death - they put her in hospice, gave her only pain meds, and poof, she’s still chugging aimlessly along.

During WW II there were caps on lots of things - my mother worked for OPA for a while. But they went away. I don’t think you can blame that for our current insurance situation. Not to mention that the number of workers without insurance coverage today makes it clear that tax benefits are not enough to “coerce” employers to offer insurance. It’s either a quality of work life philosophy, union, or competitive benefits situation - none of which would change in a totally free market. Unless your totally free market outlaws unions.

That is a statement that should be broadcast more widely!

Well it became commonplace during that period, so workers started requesting/expecting it in their negotiations for hire.

There is no motivation to cut costs. The doctors are in control of their side of the equation are are not likely to take less out of the system. The user when he has coverage has no incentive to refuse expensive and perhaps unneeded treatments. The system is broken. The holy grail of free enterprise is overused and applied wrongly. The first step of a capitalist is to limit and control competition and prices. price competition is eliminated. Look at gas prices. There is no competitive pricing in medicine. Especially since Pharm has made it illegal for the government to seek lower orices.