I was listening to a CSPAN discussion this afternoon and at issue was how the coming reform in US health care is going to be shaped. A statistic was thrown out that kind of surprised me but them again it really didn’t after thinking about it.
The elephant in the room for this panel of health care experts re nationalized health care is that in the US 27% of ALL medicare costs are spent of the last 12 months of life. The vast majority of these dollars were spent on trying to save and/or extend the lives of (typically) fairly elderly people. In this discussion several of the people participating felt this level of expenditure on borderline heroic procedures for older people who were swiftly declining with little chance of recovery (in most cases) wasn’t going to be sustainable in any workable nationalized health care system.
How the heck do you integrate the US tendency toward heroic procedures with the cost controls of national health care system?
You don’t. There will be some sort of age based rationing. They apparently do it in the U.K. LinkLink. Of course the next step will be on top of denying health care to those who don’t live the way the government thinks they should. Link
Why anyone would think giving a government bureaucrat control over personal health care is a good idea is way beyond me.
Gee, what makes you think that will be so? We don’t ration any other benefits to the elderly - you can be as wealthy as a Buffet or Gates and your Social Security payments will still come through. You’ll still be signed up for Medicare. None of these benefits have ever been means tested for the elderly.
The elderly are the single most powerful voting bloc - we’ll be switching off the incubators before we pull the plug on Grandma.
In the Netherlands, medical staff will put more effort into "Palliative Care"for people at the end of their life.
Medical treatments are not geared towards “cure”, but to make it possible for the patient to die peacefully and painlessly at home.
You have to sign up for Medicare. If you are rich ,you would not use it. My brother is 67 and has had excellent coverage ,so he never signed up. Cost to taxpayers…zero.
What’s the difference between a government bureaucrat and a corporate bureaucrat? The corporate bureaucrat tries to deny EVERY claim that they possibly can in order to make a profit.
Well, people, that’s the problem. Companies must adhere to their contracts, for if they do not they fear the law. But government has no contract, no rules. it will deny treatment categorically according to the uinterests of the bureaucracy. It will ration care, and rationing is never a wise choice in the presence of alternatives. And alternatives do exist.
Our present system has many disadvantages, but overall it does not produce worse (or better) overall treament than the rest of world’s centralized government bureaucracies. Even better, we have a great deal more opportunity to improve matters here. But taking it to the government is not the right way, and mark my words: before ten years of nationalized healthcare are out you will be screaming and whining piteously about how it didn’t turn out like you wanted. We in Tennessee have direct experience with this.
Age rationing is one way to do it, but another would be prognosis rationing. Anyone with a prognosis, say, of six months or less, as agreed upon by two medical doctors, could be put into hospice and given palliative care only. Doesn’t matter if you’re 12 or 120, if you’re in the last months of life, you should be made comfortable and come to terms with it. Spend your time doing something other than fighting a losing battle.
I agree that this would be a departure from the heroic attitude of American medicine as it’s currently practiced. I just don’t think that’s a bad thing, either monetarily, emotionally or medically. For every TV drama showing a 45 minute Code with the patient waking up completely functional, there are hundreds of 20 minute Codes in real life who wake up irreparably brain damaged or never at all. Saving lives is important and good. Saving every life isn’t.
And a corporate bureaucrat has to compete with other corporate bureaucrats at other companies, all trying to give you what you want. A government bureaucrat doesn’t have to care if his customers are happy.
And private companies will step up to offer supplemental insurance. So if you don’t want to accept the amount of care you get out of the Nationalized System, you’ll be able to insure yourself to afford more heroic measures.
Sure. I don’t have a problem with that. That’s pretty much what the UK’s system is, I believe. I don’t think we all have the right to identical health care, but I do think there should be a base minimum above ER stabilization, which should focus on preventative care and health maintenance.
As a side note, a friend told me yesterday of a system in China. (I don’t know if it’s true or not, said friend is prone to xenophilia.) In this system, the patient pays the doctor a monthly fee (not unlike concierge MDs in the US), but then when the patient gets ill, the doctor covers the cost of treatment. It’s sort of like insurance and medical care wrapped up in one, but the doctor has a direct interest in keeping the patient healthy with preventative care and timely appointments, rather than delaying treatment until chronic illness occurs. Thought provoking, at least, although I can see some drawbacks.
Name one American government agency run program that you are happy with? Name one that you have dealt with that you were impressed about how well they operate and how easy it is to get things done through the government? Based on what I have gone through I would say none.
This healthcare idea might work in other countries, but will simply be a terrible idea to have here in America. I work for the government and will say that the only thing they are good at is wastefully spending money and time. There is no incentive not to because its very hard to get fired and it isn’t their own money. This goes for all agencies, why would we want healthcare to be like this?
The Obama administration has already started “comparative effectiveness studies,” which will naturally lay the groundwork for any rationing plan. From Marginal Revolution:
Arnold Kling, who is not altogether against the idea, says:
The problem with the current system is not that we have a free market in healthcare, but that our market is far from free. The incentive systems are all screwed up. Patients have to go with the insurer that their employer mandates, regardless of how they are treated. Insurers try their best to avoid paying for medical procedures, but it’s doctors who are harmed by this, not the patient. Doctors try to do as many procedures as possible, but it’s the patient, not the insurer, that takes the fall.
Basically, you have the patient, the insurer, and the doctor. In every combination, A gets to decide how much B screws over C, rather than having his actions feed back on himself. No wonder the market is screwed up.
One way to fix this would be to have doctors bill by time, not procedure, and have insurance be an after-the-fact reimbursement of a percentage of the costs. If a doctor does too many procedures, they eat the costs and the patients go elsewhere. If the insurer fails to pay up on time, the patient picks another insurer. THAT’s the way the free market is supposed to work.
Sure. The low income health insurance I have through the State of Illinois. The one, I believe, Obama helped set up here before he went national. It’s not perfect; it’s still an insurance company (I got to pick one of three, I chose Harmony), but they emphasize well visits and even mail order OTC health supplies like cold medicine and bandages to me every month. I’d rather see a purely socialized system (with optional private coverage) because I think we’re bleeding money to the insurance companies, but if I’m constrained to an insurance model, this one’s not bad at all.
I actually forgot to bring this point up in my message. I didn’t know something like that was already going on but I can see that possibly working together (private and government). The idea that we would all have to go to government hospitals and other healthcare places is terrible. Just look at our VA hospitals and ask yourself if you would want that to be your only option even if you could afford regular private healtcare.
I love when people who have absolutelly no experience with socialized heathcare make statements againts it. It’s soooo easy to scare you with all the lies because you don’t know how it really works. Who came up with this non-sense that government will deny treatments?! Or that the quality will be worse? Or that you’ll pay high taxes? How much does it cost you now with all the deductibles, premiums, co-pays etc? How many of you can’t even afford insurance?