# Why is health care for the elderly so much more expensive in America **URL:** \ **Category:** Great Debates\ **Created:** [July 8, 2014, 3:26am UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606 "2014-07-08T03:26:06Z")\ **Posts on this page:** 13\ **Page:** 2
**Author:** ![Mijin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mijin/32/9369_2.png) [@Mijin](https://boards.straightdope.com/u/Mijin)\ **Post date:** [July 9, 2014, 7:54am UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/21 "2014-07-09T07:54:56Z")
> [@The\_Second\_Stone](#): > > Please read my next sentence after that. Then the two together. It is best for the purpose of profiting. Ah, I mis-parsed. I thought you were saying yeah it’s profit-driven but it’s still the best in the world. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [July 9, 2014, 8:15am UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/22 "2014-07-09T08:15:22Z")
> [@doreen](#): > > I’m sure it’s not that the dying Canadian him/herself accepts death any more easily than a dying American. But I’m not at all sure that the Canadian health care system doesn’t accept death more easily than the American one- I’ve known more than one case where doctors offered treatments that would at best extend life a couple of weeks or months for an already terminally ill patient. Not enough time to make a real difference in average lifespan- but enough time to spend a lot of money. I don’t know if that would happen in Canada or France or Germany. For Spain I can tell you that in general the current best practices call for the different options to be explained to the family and let them choose, but it can be a lot more complicated than that. A friend of my mother’s spent two years on Home Hospital with oxygen, getting shuffled to the local hospital twice a week for transfussions, dyalisis (not eligible for a transplant due to a list of conditions as long as a phonebook)… that when he didn’t need a tracheo or get pneumonia or whatnot. One of his daughters in law is a doctor and nurse, another is a nurse; they were the primary family contacts. When he finally went, he went in less than two days between “this is it” and CoD. And the doctor/nurse said “ok, _this_ is why we did all those treatments that had everybody looking dubious but not daring to ask. If we hadn’t, he would have drowned to death slowly over a period of weeks. This way was a bitch but the actual dying took less time and we had all had time to see it coming and accept it.” Note that this wasn’t the doctor in charge, but her choices as a family member were informed by her knowledge of medicine and of her relatives; the widow took over one year to accept that her husband was not “being a wuss”. A source of increased healthcare costs which I know my father encountered (he was Purchasing Manager for a hospital) and suspect exists everywhere is the “for medical uses” price increase. He was in charge of the hospital’s initial purchases; the quote he got for TVs for the rooms was on the six figures range - per unit. When he balked, he was told “it’s for medical use!” He called a friend at his former employer (a home electronics firm) and got the items for about 1/6 of the original quote. It was the same for anything; bedsheets were cheaper from a department store than from the pre-selected provider, because apparently there is a difference between “100% cottton” from Burrito Blanco and “100% cotton” from Burrito Blanco Medical. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [July 9, 2014, 11:21am UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/23 "2014-07-09T11:21:07Z")
> [@WhyNot](#): > > We’re going to pay for a $30,000 hospital bill because we aren’t willing to pay me $60 a week to prevent it (okay, my boss probably makes more from Medicare than I do - but still far less than for hospital care). THEN, because they’ll have changed her medications and maybe given her a new diagnosis, and because she’ll be more impaired than she is today, I’ll be able to reopen her case and resume weekly nursing visits for a while again. > > So it costs us (Medicare) more, it makes the patients worse, and it makes the doctors angry with us that we discharged them from home health. Literally no one is happy with this, but no one’s willing to change it, either. It’s actually worse than you describe. They don’t even have to pay you $60/week - they could pay a less skilled home attendant.But Medicare doesn’t pay for custodial care, and in some states Medicaid pays for nursing home care but not home care. So people like your patient end up in nursing homes when they might be able to stay at home with a home attendant a few hours a day or week. Which might contribute to the perception that Americans are more likely to use nursing homes for the elderly as well as increasing costs. My mother was finally able to get Medicaid to pay for home care (which it doesn’t do in every state) for my father , but only after they did some “Medicaid planning” and after my father spent a couple of months in a nursing home (some of which was paid for by Medicare) . He didn’t really need the sort of care you get in a nursing home- but my mother physically couldn’t care for him herself and he needed the sort of care that couldn’t wait until his children arrived home. I wonder if health care systems in other countries provide more home-care. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 9, 2014, 11:31am UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/24 "2014-07-09T11:31:07Z")
> [@brickbacon](#): > > Apparently, the [chart](http://www.motherjones.com/kevin-drum/2012/12/quick-look-us-healthcare-costs-elderly) linked to in the OP is [misleading](http://theincidentaleconomist.com/wordpress/chart-of-the-day-health-care-spending-by-age-and-country/). The US still spends a good deal more on healthcare, but that money is spent across the board, so the spike that occurs is not accurate. This is apparently because of some of the problems with the underlying data, the cherry picking of countries being compared, and the fact that it only includes public spending. Here is a [paper](http://www.federalreserve.gov/pubs/feds/2004/200414/200414pap.pdf) that compares the age distribution of healthcare spending. damn it. I will look into that later today, but if that chart is wrong that throws the entire argument out the window. ---
**Author:** ![RingsOfPylon](https://avatars.discourse-cdn.com/v4/letter/r/3da27b/32.png) [@RingsOfPylon](https://boards.straightdope.com/u/RingsOfPylon)\ **Post date:** [July 9, 2014, 12:45pm UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/25 "2014-07-09T12:45:47Z")
People don’t die easy. While I find that a lot of elderly folks I know have signed DNRs, the dying process, even an untreated one, is rarely a quick event - it is often more of a long, slow process. I have a feeling that many people think that a DNR, or a diagnosis of a terminal disease, means you die off pretty quickly and romantically, like in a 1940s movie, where you are dressed to the nines, cheerful and beautiful and pain-free, have a smile on your face, and you float happily off into the sunset maybe a week after diagnosis. So, while the patients are in the process of dying, it costs a bit of money for supportive care. It costs money to have around-the-clock care and almost-constant support and supervision even if the only treatment consists of palliative care. It can take weeks or months to die even if all treatment is stopped. It costs money to purchase equipment that makes it possible for people to die at home. Ever try to change the diaper of a dying person in a big, heavy bed that is low to the ground? Getting a hospital-type bed in the home, oxygen equipment and regular deliveries, IV setups, nursing assistants, anti-depressants and/or anti-anxiety drugs if they are still with it, perhaps a port put in to deliver pain meds (and maintaining that port) - all cost money. It would be interesting to see if drugs are a big part of the expenses. I doubt that most end-of-life types of drugs are very expensive, unless the patient is seeking a “cure”, whether real or imagined. When we went through this with my mother a couple of years ago, in the end it was cheaper to use a nursing home for palliative care than it was to have aides come in around the clock (with all of the attendant scheduling messes), let alone all of the other equipment. It’s a full time job for family members to have someone die at home. I have come to the conclusion that dying at home isn’t necessarily cheaper. In fact, it can be a fairly selfish indulgence on the part of the dying person, as weeks and months grind by and the bills pile up and family members have to neglect their other obligations in order to satisfy the dying’s wishes. And, yeah, I saw the criticisms of the data that went into the graph. It was a haphazard “study”. But the discussion around it is worth having, regardless of whether or not the conclusions have merit. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [July 9, 2014, 1:09pm UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/26 "2014-07-09T13:09:52Z")
> [@doreen](#): > > It’s actually worse than you describe. They don’t even have to pay you $60/week - they could pay a less skilled home attendant.But Medicare doesn’t pay for custodial care, and in some states Medicaid pays for nursing home care but not home care. So people like your patient end up in nursing homes when they might be able to stay at home with a home attendant a few hours a day or week. Absolutely. I \*can \*get a CNA or HHA for a patient - but only while they simultaneously have a skilled need being met by a nurse or therapist. As soon as there’s no more skilled need (because we’re good at our jobs, thanks!) then I have to yank away the CNA who’s been helping them bathe and eat and get dressed, too. This, of course, makes me very hesitant about assigning a CNA/HHA to a person - they get dependant and then they get slightly, but nowhere near completely better, and suddenly they don’t have any help at all. (I was going to bring that up in my first post, but it already seemed tldr. But you are absolutely correct.) ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [July 9, 2014, 2:10pm UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/27 "2014-07-09T14:10:37Z")
Oh, and the biggest problem with leaving just an unskilled caregiver is that they’re not allowed to touch meds. The most common not skilled need is for someone to take the pills out of the pharmacy bottles once a week and put them in a medication organizer and keep reminding the patient to take them, and let the doctor know if they aren’t taking them. An unskilled person can do the reminding and reporting, but hired ones refuse to do the set up. So we’d also need to do something to make them and their companies less scared of med set up and handing pills to the patient at the proper time. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [July 9, 2014, 4:58pm UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/28 "2014-07-09T16:58:56Z")
As someone who works in a busy urban hospital, I think there are other differences (alluded to above, perhaps, but not stated explicitly). It’s my impression that in my city (and presumably in my province, as well), there is _de facto_ rationing of health care for the ‘sick’ elderly, for demented patients, and in general for those with advanced, terminal diseases. It is a matter of routine that such patients will seldom if ever be offered things like dialysis, cardiac or other major surgery, and, to a large extent, ICU admission. Patients in those categories who _do_ receive such interventions, get them because ‘the family’ has insisted (and are the ones who bring up the possibility of those interventions in the first place). Similarly, but not in reference to terminally ill patients, things like coronary angioplasty for the elderly are done much less frequently in Canada, yet patient outcomes are much the same. Another point that I don’t think has been brought up yet is that in the Canadian system, medicolegally-driven management is much less prevalent. Simply put, we don’t order nearly as many sophisticated and expensive tests just to cover our asses as is done by docs in the US. And, along those lines, we are much less reliant on technology for diagnosis than our US counterparts. Interestingly, I am not alone in believing that this occurs in large part because the Canadian specialist exam is an oral one, i.e. our graduates know how to examine patients and are therefore not nearly as dependent on technology to make diagnoses (the US exam is all ‘paper’ based). We have lots of expatriate UK physicians in our system - they say the same applies (and more) with respect to the NIH. Sure, just hearsay, I know. ---
**Author:** ![The\_Second\_Stone](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@The\_Second\_Stone](https://boards.straightdope.com/u/The_Second_Stone)\ **Post date:** [July 9, 2014, 5:00pm UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/29 "2014-07-09T17:00:44Z")
> [@Mijin](#): > > Ah, I mis-parsed. > I thought you were saying yeah it’s profit-driven but it’s still the best in the world. It is the best in the world for profit outcomes. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [July 9, 2014, 6:54pm UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/30 "2014-07-09T18:54:44Z")
> [@brickbacon](#): > > Apparently, the [chart](http://www.motherjones.com/kevin-drum/2012/12/quick-look-us-healthcare-costs-elderly) linked to in the OP is [misleading](http://theincidentaleconomist.com/wordpress/chart-of-the-day-health-care-spending-by-age-and-country/). The US still spends a good deal more on healthcare, but that money is spent across the board, so the spike that occurs is not accurate. This is apparently because of some of the problems with the underlying data, the cherry picking of countries being compared, and the fact that it only includes public spending. Here is a [paper](http://www.federalreserve.gov/pubs/feds/2004/200414/200414pap.pdf) that compares the age distribution of healthcare spending. Thank you for that. I was skeptical of the charts in the OP when I saw that for some age groups, US health care costs were supposedly the same or even lower than in Germany. In fact everything I’ve ever seen show US costs far and away higher than any other country across the board, running somewhere at least twice the OECD average. > [@KarlGauss](#): > > It’s my impression that in my city (and presumably in my province, as well), there is _de facto_ rationing of health care for the ‘sick’ elderly, for demented patients, and in general for those with advanced, terminal diseases. It is a matter of routine that such patients will seldom if ever be offered things like dialysis, cardiac or other major surgery, and, to a large extent, ICU admission. Patients in those categories who _do_ receive such interventions, get them because ‘the family’ has insisted (and are the ones who bring up the possibility of those interventions in the first place). If this is the case for the elderly, I’ve never seen it, and my impressions completely contradict that. Part of what you’re describing is the benefits of having a patient advocate, but that applies to all patients. My mother needed occasional hospitalization well into her 90s, and I was impressed – indeed sometimes astounded – at the quality of care she received (in large Canadian urban hospitals) from everyone – paramedics, nurses, and doctors. She was given a pacemaker as a precautionary measure when she was about 95, and we had a choice of excellent facilities in which to get it done and had opportunities to speak to the doctors about the pros and cons. It ended up being done in a large research hospital by a wonderful team, and my curious fact-finding about the pacemaker itself revealed it to be one of the best and costliest of its kind. And in terms of not admitting the elderly to the ICU, she was admitted to the ICU on one occasion for several days simply because there were no beds in the cardiology ward, and other wards didn’t have the same level of monitoring provisions that they felt she needed. I understand that you work in a hospital, I’m just saying my experiences were so different than my understanding of what you describe. On the general subject of costs, the primary drivers of US health care costs are the administrative overhead of a staggeringly complex insurance system and the absence of a central authority to negotiate, standardize, and control provider fees. I don’t think drug costs, which do tend to be high in the US, is a particularly significant contributor. Brand-name prescription drugs which are protected by a patent do tend to be cheaper in Canada because they’re price controlled by the PMPRB, but generics can actually be cheaper in the US due to more robust competition. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 9, 2014, 8:48pm UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/31 "2014-07-09T20:48:45Z")
> [@brickbacon](#): > > Apparently, the [chart](http://www.motherjones.com/kevin-drum/2012/12/quick-look-us-healthcare-costs-elderly) linked to in the OP is [misleading](http://theincidentaleconomist.com/wordpress/chart-of-the-day-health-care-spending-by-age-and-country/). The US still spends a good deal more on healthcare, but that money is spent across the board, so the spike that occurs is not accurate. This is apparently because of some of the problems with the underlying data, the cherry picking of countries being compared, and the fact that it only includes public spending. Here is a [paper](http://www.federalreserve.gov/pubs/feds/2004/200414/200414pap.pdf) that compares the age distribution of healthcare spending. Supposedly the chart only focuses on public spending & excludes 5 other countries. If it only focuses on public spending that would explain why the rates jump so high between 57 and a person’s 60s. So yeah, it is looking like my OP is bullshit. Thats embarrassing. ---
**Author:** ![eclecticmn](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@eclecticmn](https://boards.straightdope.com/u/eclecticmn)\ **Post date:** [July 12, 2014, 1:02am UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/32 "2014-07-12T01:02:38Z")
> [@Nava](#): > > For Spain I can tell you that in general the current best practices call for the different options to be explained to the family and let them choose, but it can be a lot more complicated than that. > > A friend of my mother’s spent two years on Home Hospital with oxygen, getting shuffled to the local hospital twice a week for transfussions, dyalisis (not eligible for a transplant due to a list of conditions as long as a phonebook)… that when he didn’t need a tracheo or get pneumonia or whatnot. One of his daughters in law is a doctor and nurse, another is a nurse; they were the primary family contacts. When he finally went, he went in less than two days between “this is it” and CoD. And the doctor/nurse said “ok, _this_ is why we did all those treatments that had everybody looking dubious but not daring to ask. If we hadn’t, he would have drowned to death slowly over a period of weeks. This way was a bitch but the actual dying took less time and we had all had time to see it coming and accept it.” Note that this wasn’t the doctor in charge, but her choices as a family member were informed by her knowledge of medicine and of her relatives; the widow took over one year to accept that her husband was not “being a wuss”. > > A source of increased healthcare costs which I know my father encountered (he was Purchasing Manager for a hospital) and suspect exists everywhere is the “for medical uses” price increase. He was in charge of the hospital’s initial purchases; the quote he got for TVs for the rooms was on the six figures range - per unit. When he balked, he was told “it’s for medical use!” He called a friend at his former employer (a home electronics firm) and got the items for about 1/6 of the original quote. It was the same for anything; bedsheets were cheaper from a department store than from the pre-selected provider, because apparently there is a difference between “100% cottton” from Burrito Blanco and “100% cotton” from Burrito Blanco Medical. It’s nice to see factual responses like yours and some others. Many are politically based in one direction or the other. I WOULD like to see factual comparisons between countries in detail but that is boring to most and does not sell advertising time and most reporters/newsreaders are kinda stupid anyway. I read about some Indian MD doing cardiac bypasses in India for $5K with good outcomes. He was also surgeon to the Prime Minister as I recall, not some hack. He had some interesting and different systems set up. In the US there is a litigation premium added to lots of goods and services. Some companies will not even sell you some materials if they know it will be used in an implanted device. It is not worth the litigation costs. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [July 13, 2014, 2:57am UTC](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606/33 "2014-07-13T02:57:53Z")
> [@doreen](#): > > I’m sure it’s not that the dying Canadian him/herself accepts death any more easily than a dying American. But I’m not at all sure that the Canadian health care system doesn’t accept death more easily than the American one- I’ve known more than one case where doctors offered treatments that would at best extend life a couple of weeks or months for an already terminally ill patient. Not enough time to make a real difference in average lifespan- but enough time to spend a lot of money. I don’t know if that would happen in Canada or France or Germany. I’m watching it happen right now. They sure do. My father has terminal cancer, and they’re going to no small effort to extend his life (as well as improve the quality of life while it happens.) They stretched my grandmother’s life out, too, probably past the point they really should have in my opinion but that wasn’t my call. It’s going to depend on the wishes of the family, and families in France or Canada are not really going to be that much different from ones in Iowa. [Previous page](https://boards.straightdope.com/t/why-is-health-care-for-the-elderly-so-much-more-expensive-in-america/692606.md?page=1)