# What policy changes are being proposed to lower healthcare costs? **URL:** \ **Category:** Great Debates\ **Created:** [October 28, 2015, 4:59pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987 "2015-10-28T16:59:42Z")\ **Posts on this page:** 8\ **Page:** 2
**Author:** ![halman](https://avatars.discourse-cdn.com/v4/letter/h/5f9b8f/32.png) [@halman](https://boards.straightdope.com/u/halman)\ **Post date:** [October 30, 2015, 12:28pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/21 "2015-10-30T12:28:29Z")
As long as one of the parties in health care is assured of making a profit on every transaction, costs will not come down. Health care is a transaction between a provider and a patient. The insurance companies got involved when people started having problems paying medical bills as they got older. Suddenly, you had to have health insurance to see a doctor, unless you were wealthy enough to pay for all the services at the time they were rendered. The insurance companies decide what they will pay for a procedure, or a medical item, based upon what their profit will be. So all of the infrastructure involved in reviewing claims, settling claims, filing claims, contesting claims, etc. has to be paid for from profits made from selling insurance. Healthy people must subsidize people who are sick, because the sick have paid in advance to get care, even if it exceeds what they have paid in. When the last six weeks of your life will usually consume something like three quarters of the care receive over your whole life, that gets expensive. Our medical system has a problem with saying “This person is old and they are going to die. Nothing we can do will stop that.” They can’t let you die, they have to kill you with one treatment after another, regardless of the quality of your life. And families refuse to take responsibility for their elders, handing them off to someone else to care for. Dying at home is almost unheard of anymore, you have to be in some kind of an institution if you are going to die. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [October 30, 2015, 2:27pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/22 "2015-10-30T14:27:06Z")
> [@halman](#): > > Our medical system has a problem with saying “This person is old and they are going to die. Nothing we can do will stop that.” They can’t let you die, they have to kill you with one treatment after another, regardless of the quality of your life. And families refuse to take responsibility for their elders, handing them off to someone else to care for. Dying at home is almost unheard of anymore, you have to be in some kind of an institution if you are going to die. To be fair, as someone who has multiple family members that work in long-term elder care and hospice, it is very rarely the medical professionals who have a problem accepting end of life. In fact, I think most studies show that doctors generally request far less intervention in their own end-of-life care than non-physicians do. The problem is that patients (and often more significantly families) do not file DNR requests or have medical health directives. Which is exacerbated by the fact that physicians are not paid by Medicare for time spent counseling patients and their families on the need for such things (thanks, in large part, to the “death panels” attack). Those I know that work extensively with dying patients say the most heart-breaking part of the work is not seeing their patients die, but often seeing their ends prolonged. ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [October 31, 2015, 3:19am UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/23 "2015-10-31T03:19:28Z")
> [@Jas09](#): > > The problem is that patients (and often more significantly families) do not file DNR requests or have medical health directives. Which is exacerbated by the fact that physicians are not paid by Medicare for time spent counseling patients and their families on the need for such things (thanks, in large part, to the “death panels” attack). [Not anymore](http://www.opb.org/news/article/feds-say-doctors-can-now-be-paid-for-end-of-life-conversations/). ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [October 31, 2015, 2:11pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/24 "2015-10-31T14:11:38Z")
> [@Nobody](#): > > [Not anymore](http://www.opb.org/news/article/feds-say-doctors-can-now-be-paid-for-end-of-life-conversations/). This is excellent news from the perspective of personal autonomy and person-centered care and planning. It’s hard to say if this will have much impact on healthcare costs in general. ---
**Author:** ![lance\_strongarm](https://avatars.discourse-cdn.com/v4/letter/l/87869e/32.png) [@lance\_strongarm](https://boards.straightdope.com/u/lance_strongarm)\ **Post date:** [October 31, 2015, 4:30pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/25 "2015-10-31T16:30:03Z")
> [@ITR\_champion](#): > > A short while ago, [I proposed one](http://boards.straightdope.com/sdmb/showthread.php?t=722767): make birth control and numerous other medications available over-the-counter, rather than by prescription only. That probably wouldn’t lower the cost. It would just shift the cost from insurance companies to an out-of-pocket expense for birth control users. (Which was why the GOP proposed it and the Dems oppose it–it was designed to get the birth control coverage mandate out of the ACA). ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [October 31, 2015, 6:17pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/26 "2015-10-31T18:17:31Z")
> [@Nobody](#): > > [Not anymore](http://www.opb.org/news/article/feds-say-doctors-can-now-be-paid-for-end-of-life-conversations/). That is excellent (and timely) news. Previously many doctors would have those conversations without being paid, and some HMOs would reimburse for it. Thanks for the update. ---
**Author:** ![lance\_strongarm](https://avatars.discourse-cdn.com/v4/letter/l/87869e/32.png) [@lance\_strongarm](https://boards.straightdope.com/u/lance_strongarm)\ **Post date:** [October 31, 2015, 6:21pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/27 "2015-10-31T18:21:16Z")
> [@Shodan](#): > > As I said, when it comes to GOP proposals to reduce costs, the Dems suddenly lose interest in reducing costs. > > Regards, > Shodan Sometimes the GOP’s efforts to “reduce costs” are a sham designed to do something very different. ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [October 31, 2015, 8:40pm UTC](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987/28 "2015-10-31T20:40:22Z")
> [@jsgoddess](#): > > This is excellent news from the perspective of personal autonomy and person-centered care and planning. It’s hard to say if this will have much impact on healthcare costs in general. Agreed. I just wanted Jas09 (and everybody else) to know that things have changed. You know, fighting ignorance an all. 🆒 > [@Jas09](#): > > That is excellent (and timely) news. Previously many doctors would have those conversations without being paid, and some HMOs would reimburse for it. > > Thanks for the update. You’re welcome. [Previous page](https://boards.straightdope.com/t/what-policy-changes-are-being-proposed-to-lower-healthcare-costs/735987.md?page=1)