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.
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.
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.
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).
