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Obama's three principles of health reform: First, reduce costs.

[the three principles]

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.

Doctoraaron's take:

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.

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vastleft's picture
Submitted by vastleft on

Since this election was about change, why don't we change our health care policy so that the money that used to go to Medicare now goes to young people, so they can buy health insurance from uniquely American private companies?

Older people will still have to pay into the plan, but that's to punish them for ruining everything with their partisan bickering, especially during the 1960s, with their divisive concerns about civil rights, women's rights, etc. And their disgusting oldness.

Submitted by hipparchia on

Since this election was about change, why don't we change our health care policy so that the money that used to go to Medicare now goes to young people, so they can buy health insurance from uniquely American private companies?

i maintain that we're already doing that, ackshully. good data is hard to come by when you're just a blogger sitting at your dining room table, but it looks to me like, compared to other countries, we're spending less on our old people and more on our under-65s than they are.

vastleft's picture
Submitted by vastleft on

And a lot of young adults "go naked" on insurance. The renewed focus on cost-control, demonizing of "entitlements," workplace-based private insurance plans, and overall animus toward the un-young and un-cool suggests that change is icumen.

Submitted by hipparchia on

i'd say it's a war on the rest of us by the privileged few and stoking intergenerational bad feeling is just one of their many tools.

as far as i can tell [hard to read the tea leaves, they're all being cagey, not just obama] one of the changes that health care deform is going to include is increasing the number of people who are going to be eligible for medicaid/schip, which is being taken over by the private insurers and from which, coincidentally, a few people are going to profit handsomely.