# Nationalized health care vs insane end of life medical costs in the US **URL:** \ **Category:** Great Debates\ **Created:** [May 17, 2009, 1:50am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701 "2009-05-17T01:50:12Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [May 20, 2009, 4:20pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/81 "2009-05-20T16:20:49Z")
> [@Boyo\_Jim](#): > > I can tell you one thing that really drives up end of life costs. When religious fanatics try to keep already dead people on life support so God can work a MIRACLE! Do you have a reliable cite for this? Keep in mind that the plural of anecdote is not data. Thanks in advance. Regards, Shodan ---
**Author:** ![Boyo\_Jim](https://avatars.discourse-cdn.com/v4/letter/b/87869e/32.png) [@Boyo\_Jim](https://boards.straightdope.com/u/Boyo_Jim)\ **Post date:** [May 20, 2009, 4:25pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/82 "2009-05-20T16:25:37Z")
> [@Shodan](#): > > Do you have a reliable cite for this? Keep in mind that the plural of anecdote is not data. > > Thanks in advance. > > Regards, > Shodan You need a cite to demonstrate that it costs more to keep someone breathing on a respirator in an ICU rather than switching off their life support? ---
**Author:** ![DoctorJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctorj/32/2904_2.png) [@DoctorJ](https://boards.straightdope.com/u/DoctorJ)\ **Post date:** [May 20, 2009, 5:13pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/83 "2009-05-20T17:13:23Z")
> [@Boyo\_Jim](#): > > You need a cite to demonstrate that it costs more to keep someone breathing on a respirator in an ICU rather than switching off their life support? Of course it does, but I’m not sure this is common enough to add significantly to the kind of health care costs we’re talking about here, especially if you limit it to those who maintain futile life support for religious reasons. In my experience, most of the cases where someone ends up on futile life support are due to indecisiveness on the part of the family, disputes within the family, failure to accept the diagnosis, or just an inability to let go. Religious fanaticism rarely comes into it. True nutjobbery like you saw from Terri Schiavo’s parents and their enablers is thankfully rare. ---
**Author:** ![Garula](https://avatars.discourse-cdn.com/v4/letter/g/ea666f/32.png) [@Garula](https://boards.straightdope.com/u/Garula)\ **Post date:** [May 20, 2009, 11:50pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/84 "2009-05-20T23:50:07Z")
I would be much more amenable to UHC if we took special care to make sure the care provided to politicians, their families, and their friends were open to public scrutiny. A possibility that worries me greatly is that it will become a system where “knowing someone” will get strings pulled such that you receive care far better than the norm. I’d be much more comfortable with the idea if I were certain that the interests of the people in charge synced up with my own. ---
**Author:** ![GSV\_Consolation\_of\_Dreams](https://avatars.discourse-cdn.com/v4/letter/g/f1d935/32.png) [@GSV\_Consolation\_of\_Dreams](https://boards.straightdope.com/u/GSV_Consolation_of_Dreams)\ **Post date:** [May 21, 2009, 7:27am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/85 "2009-05-21T07:27:57Z")
> [@Garula](#): > > I would be much more amenable to UHC if we took special care to make sure the care provided to politicians, their families, and their friends were open to public scrutiny. A possibility that worries me greatly is that it will become a system where “knowing someone” will get strings pulled such that you receive care far better than the norm. I’d be much more comfortable with the idea if I were certain that the interests of the people in charge synced up with my own. You mean to say you think this doesn’t happen under your present system? :dubious: ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [May 21, 2009, 12:36pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/86 "2009-05-21T12:36:46Z")
> [@DoctorJ](#): > > Of course it does, but I’m not sure this is common enough to add significantly to the kind of health care costs we’re talking about here, especially if you limit it to those who maintain futile life support for religious reasons. > > In my experience, most of the cases where someone ends up on futile life support are due to indecisiveness on the part of the family, disputes within the family, failure to accept the diagnosis, or just an inability to let go. Religious fanaticism rarely comes into it. True nutjobbery like you saw from Terri Schiavo’s parents and their enablers is thankfully rare. My sister worked in the ICU of a VA hospital, where it was common - but not for religious reasons. The widow often couldn’t afford to live off the reduced pension and social security once her husband died, so she would keep him alive as long as possible to stretch out the checks. As long as he wasn’t in pain and the VA was picking up the bills…Sad that we’d spend tens of thousands of dollars a month keeping a man alive so his wife could get an extra $200 a month. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [May 21, 2009, 1:42pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/87 "2009-05-21T13:42:25Z")
> [@Boyo\_Jim](#): > > You need a cite to demonstrate that it costs more to keep someone breathing on a respirator in an ICU rather than switching off their life support? No, I need a cite to demonstrate that a significant factor driving up end of life costs is religious fanatics trying to keep already dead people on life support so God can work a MIRACLE! That’s what you claimed, so I would like to know what the basis is for the claim. Thanks in advance. Regards, Shodan ---
**Author:** ![Boyo\_Jim](https://avatars.discourse-cdn.com/v4/letter/b/87869e/32.png) [@Boyo\_Jim](https://boards.straightdope.com/u/Boyo_Jim)\ **Post date:** [May 21, 2009, 2:07pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/88 "2009-05-21T14:07:38Z")
I apologize for not speaking more clearly. What I _meant_ was that when religious nuts intervene to prevent death\* by insisting on ventilators, etc., and refusing to allow the body to die\*, the end of life costs for that person go through the roof. I don’t know how many cases there are like the Schiavo one – probably none so contentious because of the debate within the family. I do know, that even in my own family, my mother’s body was kept alive\* for some time because my father couldn’t accept her death. (I include my father as a religious nut, btw.) However, I can’t quantify how often this happens or the total costs to the medical system as a whole. - – I can’t define what exactly constitutes death, but it’s arguable that many bundles of living cells that look like human beings are effectively dead. ---
**Author:** ![The\_Tao\_s\_Revenge](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@The\_Tao\_s\_Revenge](https://boards.straightdope.com/u/The_Tao_s_Revenge)\ **Post date:** [May 21, 2009, 3:33pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/89 "2009-05-21T15:33:56Z")
> [@Fotheringay-Phipps](#): > > First choice is correct. > > I know what you meant. I think your approach is silly. Hence the parody. Ahh I see. Rather then say why you disliked my approach you choose to write an obtuse post and waste my time trying to figure out what the hell you’re on about. Instead of just coming out and saying what you thought. Kinda weak dude. Now on the subject of my approach, it’s strategy. If you’re gonna argue an idea you’ll have much better luck presenting it in a way that’s appealing to those in your audience. The Jingoistic crowd really believes in America. The line “It won’t work here” is actually calling the whole nation incompetent compared to the rest of the world, a slur against America. So lets get fired up and show those asshats why they’re wrong. Which was the tone of my post. The jingoistic crowd also tends to have a lot of overlap with the antiUHC crowd. By making one of their arguments unpatriotic you take the teeth out of it, and have a good counter argument. “it won’t work here? are you saying America can’t do what the rest of the world does easy?” Then you go into stats, costs, etc. without having to deal with “we’re different just because we are” crap. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [May 21, 2009, 3:43pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/90 "2009-05-21T15:43:25Z")
> [@The\_Tao\_s\_Revenge](#): > > Now on the subject of my approach, it’s strategy." IOW you personally don’t find what you write compelling but think the “jingoistic crowd” will? I certainly agree with the first half … > [@](#): > > If you’re gonna argue an idea you’ll have much better luck presenting it in a way that’s appealing to those in your audience. The first step is understanding them. If you think your target audience is “asshats” there’s reason to suspect that your wooing might not be success, and in fact, you might not be the right suitor altogether … ---
**Author:** ![Starving\_Artist](https://avatars.discourse-cdn.com/v4/letter/s/aeb1de/32.png) [@Starving\_Artist](https://boards.straightdope.com/u/Starving_Artist)\ **Post date:** [May 21, 2009, 4:40pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/91 "2009-05-21T16:40:05Z")
> [@The\_Tao\_s\_Revenge](#): > > The line “It won’t work here” is actually calling the whole nation incompetent compared to the rest of the world, a slur against America. I’d say it’s more a slur against the ability of the U.S. government to function effectively, myself. The U.S. government is notoriously wasteful and bureaucratic, penurious with benefits, and answerable to no one. I also think it may well be largely a fiction that UHC works all that well in European countries. (I recall even here on the boards a poster from Canada’s vaunted system whose mother had to wait eight months for cancer surgery.) And to the degree it does, that is no guarantee that it will not collapse as time goes by. To my mind there are a couple of things that enter into the claim that UHC works so well in Europe. For one, people get used to things…especially if that’s all they have. When you have no other choice, you accept you what you get and it becomes the norm. Then once it’s become the norm, problems and drawbacks get written off as being just the way things are. A secondary reason is that it’s very likely that, just like here, the people who are most happy with it are people who take the view that they would have nothing otherwise. The fact that it’s better than nothing is hardly a ringing endorsement of how well it works. I’d opt any day for a system that provides excellent to adequate care, virtually immediately, for approximately seventy to eighty percent of the population to one that provides so-so care, long waits and their resultant worsening of illness and/or death, and endless red tape, for one hundred percent of the population. But lefties for some reason seem perfectly happy to accept substandard-to-terrible results as long as nobody is getting more or better than somebody else. You see this same effect in communist countries where everybody lives in crackerbox apartments or tiny houses, long lines are required for the most basic of amenities, and nobody has anything to speak of, and yet one hears time after time from members of the left about how communism is the most perfect form of government. In short, I perfer a system that works very well for most rather than one that’s tortured and substandard for everyone. I do think that some sort of system should be established to assist people who are truly poor or who can’t get health insurance otherwise, but I strongly object to bringing the entire population under the auspices of the United States government for its health care. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [May 21, 2009, 5:06pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/92 "2009-05-21T17:06:11Z")
> [@Tim\_R.Mortiss](#): > > And a corporate bureaucrat has to compete with other corporate bureaucrats at other companies, all trying to give you what you want. What you’re overlooking is that the corporate bureaucrat has to compete with other corporate bureaucrats at the _same_ company, because showing that you can cut company expenditures to the company leads to advancement. Corporate health care simply has too much of an incentive to deny claims and not enough disincentive to pay them. This booga-booga spectre of “government bureaucrat” is a way to protect profit, not health or choice. ---
**Author:** ![Starving\_Artist](https://avatars.discourse-cdn.com/v4/letter/s/aeb1de/32.png) [@Starving\_Artist](https://boards.straightdope.com/u/Starving_Artist)\ **Post date:** [May 21, 2009, 5:23pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/93 "2009-05-21T17:23:01Z")
> [@Bryan\_Ekers](#): > > What you’re overlooking is that the corporate bureaucrat has to compete with other corporate bureaucrats at the _same_ company, because showing that you can cut company expenditures to the company leads to advancement. This is true in a limited sense, but insurance companies are still bound by the terms of their contracts, they still depend on their reputations to acquire new customers, and they are subject to lawsuits and regulatory oversight in the event they go too far…none of which applies to government health care. > [@Bryan\_Ekers](#): > > Corporate health care simply has too much of an incentive to deny claims and not enough disincentive to pay them. This booga-booga spectre of “government bureaucrat” is a way to protect profit, not health or choice. The “booga-booga” spectre of the government bureaucrat is due to the very real fact that they exist. Or have you never had to deal with a government bureaucracy? And besides, the government will be just as limited in resources (if not moreso) and as cost-conscious as any corporation when it comes to doling out care, and unlike corporations who are bound by contractual obligations and the force of law, the government can decide on a daily basis what it has the money to cover and what it doesn’t and can do whatever it wants accordingly. I don’t want my health care decisions being made on the basis of whether or not the government can pay for it. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [May 21, 2009, 5:35pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/94 "2009-05-21T17:35:08Z")
I actually think the government will stick it to the doctors before they do it to the public. IOW, lessen the level of reimbursement paid to providers, and incur the wrath of their lobbyists rather than the wrath of the public. (This effect already exists in the case of Medicare reimbursement rates.) Step 2 is when the top providers opt out of the system. Truth is that even now a lot of the top providers don’t accept insurance. But their charges can be offset by out-of-network insurance coverage, which many or most people have. I don’t know how widespread supplementary insurance would be under a UHC plan - I don’t see employers jumping at the chance to offer this. So you could end up having the same two-tiered health care system, but you’d need to be even richer to get into the club. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [May 21, 2009, 7:19pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/95 "2009-05-21T19:19:14Z")
> [@Starving\_Artist](#): > > This is true in a limited sense, but insurance companies are still bound by the terms of their contracts, they still depend on their reputations to acquire new customers, and they are subject to lawsuits and regulatory oversight in the event they go too far…none of which applies to government health care. Well, it _can_ apply if the laws are set up that way. It’s certainly possible for a citizen to sue a government agency. Corporations can indeed get sued, which is why they have lawyers on retainer and can operate on the principle that all they need do is delay long enough and the policy-holder filing a claim will either die or run out of funds. I could buy the “reputation” argument if the marketplace was such that every individual could pick and choose their personal medical insurance. As I understand the American system, though, most get insurance through their employers, who (naturally enough) have their own interests in mind. This isn’t a slam against capitalism, which I love. In this particular case and for this particular industry, I just don’t see the point of general-purpose private medical insurance when its existence makes the overall system more expensive and less useful, the same way I’d feel about private fire departments. > [@](#): > > The “booga-booga” spectre of the government bureaucrat is due to the very real fact that they exist. Or have you never had to deal with a government bureaucracy? Yes, every time I use my provincial health card. It’s actually quite painless. The mistake is in assuming that a government bureaucrat must automatically be worse than a corporate bureaucrat. Actually, I _did_ have one bad experience - a private insurance company initially declining dental coverage (covered by my employer, since the provincial system doesn’t automatically cover dental) because they thought the procedure was cosmetic in nature. I wrote one letter explaining that it wasn’t and got satisfaction. > [@](#): > > And besides, the government will be just as limited in resources (if not moreso) and as cost-conscious as any corporation when it comes to doling out care, and unlike corporations who are bound by contractual obligations and the force of law, the government can decide on a daily basis what it has the money to cover and what it doesn’t and can do whatever it wants accordingly. And that would be worse than what you now have… how? The contractual obligations you describe are not absolute - they’re only enforceable if the courts _say_ they are, and even getting to court can take months or years. > [@](#): > > I don’t want my health care decisions being made on the basis of whether or not the government can pay for it. Unless you’re independently wealthy, somebody somewhere is going to make that decision. At the very least, the corporate bureaucrat has a personal incentive to say no, while the government bureaucrat does not. ---
**Author:** ![sleestak](https://avatars.discourse-cdn.com/v4/letter/s/919ad9/32.png) [@sleestak](https://boards.straightdope.com/u/sleestak)\ **Post date:** [May 22, 2009, 3:52am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/96 "2009-05-22T03:52:55Z")
> [@Bryan\_Ekers](#): > > At the very least, the corporate bureaucrat has a personal incentive to say no, while the government bureaucrat does not. The government bureaucrat won’t have \*any \*incentives to say yes. In fact, they may not even have the option to say yes. [Link](http://www.macular.org/news/nocmspr.html) > [@](#): > > Leading disability and aging organizations today announced their determination to fight the March 29, 2002 decision by the Centers for Medicare and Medicaid Services (CMS) to deny national Medicare coverage of ocular photodynamic therapy (OPT) with verteporfin (“Visudyne”) for the treatment of age-related macular degeneration (AMD) with occult lesions. By reversing its October 2001 decision to expand the national coverage policy for this treatment, CMS has denied Medicare beneficiaries access to the only effective treatment available to prevent this condition which is a leading cause of blindness in people aged 50 and over. > > The organizations joining forces to prevent vision loss and oppose the CMS action include: The American Association of People with Disabilities (AAPD), the American Council of the Blind (ACB), the Alliance for Aging Research and the American Macular Degeneration Foundation. > > “We are deeply saddened at the specter of people losing their vision when the outcome could have been so different and so positive,” said Charles Crawford, Executive Director of the American Council of the Blind. “The harm done by this decision is sufficiently severe to warrant continued advocacy aimed at reversing this tragic decision.” > > AMD involves the deterioration of the central region of the retina called the macula, which results in a severe and irreversible loss of central vision. The National Institutes of Health estimates that 1.7 million elderly Americans, or 5 percent of the total population over 65 years of age, have some degree of vision loss due to AMD. > > A recent report released by the National Eye Institute found that blindness is one of the most feared disabilities. By reversing its original decision, CMS has denied Medicare beneficiaries with AMD their only therapeutic alternative. According to the Vitreous Society – the largest national organization of doctors specializing in diseases of the retina and vitreous body of the eye – at least one out of four Medicare beneficiaries will be denied entitlement under the Social Security Act as a result of this non-coverage decision. > > In October 2001, CMS issued a national coverage decision memorandum, announcing the agency’s intention to cover OPT with verteporfin for AMD patients with occult lesions. At that time, CMS estimated that approximately 35,000 to 70,000 Medicare beneficiaries would benefit from this decision, tripling the number helped by this treatment. CMS’s announcement prompted the Secretary of Health and Human Services (HHS) to issue a press statement on October 19 saying: “By expanding access to this important new treatment, we are improving the quality of life for many Medicare beneficiaries.” > > The March 29 reversal by CMS is particularly troubling given Secretary Thompson’s recent statement in the latest issue of Inside CMS, (March 28, 2002) that “Healthy vision is a shared responsibility among the government, health care providers, community leaders, and the public.” > > “The American Association of People with Disabilities is baffled by CMS’s decision to deny Medicare coverage for a therapy that is considered the ‘standard of care’ by the American Academy of Ophthalmologists and by retinal specialists across the country,” said Andrew J. Imparato, President and CEO of AAPD. “Now only the wealthy will have access to this sight saving treatment for AMD, the leading cause of blindness in the Medicare population.” So the only medical care some older folks have[li](http://www.aarp.org/research/medicare/coverage/fs149_medicare.html), which is run by the government, decided that if you have a certain disease you get to go blind. Even though there is treatment. [/li] Heck, it took President Bush to finally make a change in 2002 to cover Alzheimer’s. [Link](http://www.nytimes.com/2002/03/31/us/medicare-is-now-covering-treatment-for-alzheimer-s.html). Slee ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [May 22, 2009, 4:03am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/97 "2009-05-22T04:03:54Z")
Yes, there are problems and horror stores, but I don’t see how having the issue in private hands is better. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [May 22, 2009, 1:11pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/98 "2009-05-22T13:11:08Z")
> [@WhyNot](#): > > 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. I have read this 27% statistic before and suspect that most of those expenses relate to advanced cancer treatments. I’ve seen the bills, an IV chemo combined with a drug like Tarceva and all the white cell supplements and drugs for the chemo symptoms cost our insurance company over 50K a month. The issue with prognosis rationing, as I see it, is that these expensive treatments sometimes work. If we take stage 4 pancreatic cancer, which has the worst prognosis… 30,000 new case a year prognosis average 6 months at diagnosis and a .05 percent 5 year survival rate. Denying these treatments may seem like a no brainer, but these grim .05 5 year survival rate equals 1500 people per year who are put into a deeply extended remission by these treatments and a handful of actual cures. I have met a few 15 year+ survivors. Furthermore, these survivors are telling their stories to other patients and the drug companies use these stories to promote the chemo drugs. Working with statistics may be fine in practice, but everything changes when the patient is you…or your husband, or your Mom. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [May 22, 2009, 2:08pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/99 "2009-05-22T14:08:09Z")
> [@Sound Mind](#): > > Working with statistics may be fine in practice, but everything changes when the patient is you…or your husband, or your Mom. No, not really. Fine [Appeal to Emotion](http://en.wikipedia.org/wiki/Appeal_to_emotion), though. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [May 22, 2009, 7:36pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/100 "2009-05-22T19:36:11Z")
On the subject of health care costs, insane or otherwise: We’ve heard a lot (including from the Obama Administration) about how creating nationwide eletronic medical records (EMR) by hospitals and medical practices will save lots of money and help finance government-guaranteed health care. I was at a seminar this week that discussed EMR phase-in, and it was stated that for a medium to large-sized multi-physician clinic, the start-up EMR cost was $44,000. _Per physician_. If there are a dozen docs in the clinic, that’s about $500,000. Add in the annual cost of maintaining system functionality and security, and that’s another $240,000 for those 12 doctors. Of course, those are only the current cost estimates. The Administration has allocated some funds to help finance EMR start-up, but that won’t remotely cover what needs to be done across the U.S. There are also something like 200-300 different EMRs being marketed, not all of which are suitable for a given practice/hospital setting. If, despite all precautions you wind up with an EMR that doesn’t work for you, there’s the cost of getting rid of it and salvaging all the patient data, then buying yet another system. Now, I think EMRs are a good idea, and I love the setup at my hospital that allows me to rapidly access lab, radiology and clinical reports so I can better diagnose a patient’s disease. Ultimately, if good systems are used and concerns about security of patient info are resolved, I think patient care will benefit from EMRs. But this is not going to be cheap. It’ll cost _more_ than what we’re spending now on paper records. And anyone who claims big cost savings is misinformed or lying. This is a theme we’ll be revisiting over and over as we move towards universal coverage, a good and necessary thing in my view. However we should all be prepared to pay more and experience some health care rationing as the price of universal care. Those with pretty good plans now are not going to be happy. [Previous page](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701.md?page=4) [Next page](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701.md?page=6)