Obama's three principles of health reform: First, reduce costs.
Having been a
patient healthcare consumer once or twice myself, I've had occasion to see how the insurance companies intrude in the practice of medicine, and how much time they suck out of the doctor's day.
But don't believe me, let a family doctor detail one of his workdays for you.
An added bonus, for me, was an issue that one of the commenters brought up: end of life care. A lot of Very Serious People think we spend waaaaay too much on the dying, and a lot of ordinary people have bought into this.
I also have thought carefully about how much money is used in the care of my patients towards the end of life and have thought about how one would go about reducing that expenditure.
Very often the expenditure couldn't be reduced significantly because, as you are providing that care, it is not at all clear when it is appropriate to end that care.
As he pointed out in one of his other comments, "it is often very difficult to know when the end is near." Anybody who has ever had a lot of pets has probably had ample opportunity to judge this for themselves.
An interesting side note on this comes from a study done by Medicare. One thesis of the end-of-lifers [as I've come to think of them] is that now that we have so much more new and shiny and expensive technology available, teh greedy old folks who refuse to die are costing us an arm and a leg [really, they're not going to need those arms and legs where they're going].
Not so fast, says Medicare:
Their findings belie perceptions that a larger percentage of medical expenses are accounted for by terminally ill persons whose lives were prolonged by expensive technology. Gerald Riley, a HCFA actuary, conducted the analysis with colleague James Lubitz and published it in the 1993 New England Journal of Medicine. They found no evidence that elderly persons in the last year of life account for a larger share of Medicare expenditures today than before the onslaught of technology.
In fact, Medicare paid the exact same percentage for patients in the last two months of life in 1976 as in 1988. This implies that heroic efforts to preserve life in the last months did not have a disproportionate effect on increasing the proportion of Medicare outlays.
Granted, that Medicare study was done on data from 1975, 1980, 1985, and 1988 and a lot could have changed since then, but none of the very serious are proposing to do an updated version of that study. Indeed, it might derail their visions of cutting entitlement spending to find that not much has changed in the last 20 years after all.
Seems to me that before we consign our old people to the ice floes, we should first demand a little more proof that they're eating us alive.