Re: The Problem With the U.S. Health Care System
- From: "John Galt" <whoisjohngalt@xxxxxxxxxxxxxx>
- Date: Thu, 23 Aug 2007 10:09:50 -0500
"noname" <noname@xxxxxxxxxxx> wrote in message
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On Thu, 23 Aug 2007 09:30:37 -0500, "John Galt"
<whoisjohngalt@xxxxxxxxxxxxxx> wrote:
"noname" <noname@xxxxxxxxxxx> wrote in message
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On Wed, 22 Aug 2007 22:45:06 -0500, "John Galt"
<whoisjohngalt@xxxxxxxxxxxxxx> wrote:
"mg" <mgkelson@xxxxxxxxx> wrote in message
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I suspect that one of the biggest problems with the U.S. health careI've heard estimates that it's as much as 80% of your entire life's
system is the money spent by society to keep us old farts alive for a
few more years. First we probably can expect to rack up $100,000-
$200,000 in medical expenses and then another couple of hundred
thousand in a rest home.
We Americans believe that life is priceless, but now we're starting to
realize we really can't afford the price.
health
care costs are vended in the last two years of your life here. I've
wondered
if that part of the "economies of scale" found in goverment-run systems
comes from restricting some types of treatments at the end of life.
JG
Since no one knows for sure exactly when someone will die, how would
this work out in real life? How would you determine when the end of
anyone's life is due to come? Have you thought about that?
Sure. There are plenty of statistics concerning certain potentially
terminal
diseases. Let's talk cancer, for example.
My mom was diagnosed with advanced-stage cancer in 2005. That statistics
(which, of course, the doctor will never tell you) is that only 8% of the
population with that cancer at that stage survive past five years. I'll
wager that most of those are the odd-case where the cancer has appeared in
a
younger, otherwise healthy indivdiual. My mom was 75.
So, we engage in one, two, and three courses of chemotherapy, all of which
had very little effect on the advance of the cancer. I suspect (don't know
for sure) that after the first course was found to have failed, my mom's
chances of survival were probably down under 2%. After the second round,
probably under 1%. However, a third round was still ordered.
Now, a saner system (and an actually more humane one) probably would have
some sort of metric where the patient goes to end-of-life care after the
first round, or certainly the second. However, we went ahead and spent
(well, not us, but Medicare) another fifty grand on the last round anyway.
This brings me to the issue. If you're going to cut the costs inherent in
a
system, you gotta cut somewhere. The logical place to cut is at end of
life,
when it is well known by medical standards that further treatment is
futile.
Now, tell that to an emotional son or daughter (or even the patient) at
the
end of life. If you can sell that one, you can sell anything.
JG
Tell it to me. I am age 77 and not worthy of treatment for a serious
disease? Thanks alot. Tell you what. You go first and then perhaps
I'll think about it.
Don't misunderstand me. The QUESTION here is how the other systems in the
world treat the situation. To return to my original statement, I SUSPECT
that in the US you get more extensive EOL treatment than in other countries,
and that's one of the reasons why their care systems are cheaper.
Any care system requires some sort of giveback. If you want lower costs, you
can trade off quality, physician choice, or on-demand care. One of the first
things I ever ask anyone is which one they want to give up for lower costs.
(The example I gave fits into the "on-demand" category).
Quality, of course, is off the table. Both of the other two were tried by
the HMOs, and ended up being eviserated by patient complaints and "Bill of
Rights" legislation. So, the very mechanisms by which the HMOs originally
controlled costs were unpopular and removed, after which, HMOs started
(quite expectedly) to get more expensive.
So, we're in a pickle. To reform health care, the politicians have to
convince the rest of the country to give up physician-choice or on-demand
care, and they have to do so while the largest voting block in history is
also the largest consumer of health care.
Of course the wealthy could pay for their own treatment, right? And
your plan would present some ethical conflicts for many doctors as
well. Would you pass a law that a doctor could not treat an elderly
person for more than X amount of time for some ailment even if that
person could pay for it?
Obviously not. The *point* here is that insurance systems (public, private,
whatever) have a cost incentive to withhold care under ANY circumstance, and
if it can be argued that the care to be vended is futile (you may remember
the controversy over Mickey Mantle's liver transplant), then the on-demand
variable plays in.
I am not saying a person should not decide on their own to reject
further treatment if the odds are way against them. But that is a
personal decision.
Today, under the current system, that's true.
JG
.
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