Relentlessly Increasing Medicare Costs

[Perknose]

Perhaps we could start here.

Medicare, the government?s health plan for the elderly, spends about one-third of its budget on people who are in the last year of life, and much of that on patients at the very end of life.

. . . patients who were devout were three times as likely as less religious ones to be put on a mechanical ventilator to maintain breathing during the last week of life, and they were less likely to do any advance care planning, like signing a do-not-resuscitate order, preparing a living will or creating a health care proxy, the analysis found.

[...]

. . . 11.3 percent of the most religious patients received mechanical ventilation during the last week of life, compared with only 3.6 percent of the least religious.

What bunch of anti-religious commies came up with THIS?

The study is to be published Wednesday in The Journal of the American Medical Association.

?People think that spiritual patients are more likely to say their lives are in God?s hands ? ?Let what happens happen? ? but in fact we know they want more aggressive care,? said Holly G. Prigerson, the study?s senior author and director of the Center for Psychosocial Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston.

It's just money!

Aggressive end-of-life care can lead to a more painful process of dying, researchers have found, and greater shock and grief for the family members left behind.

Ok, these are tough questions and tougher trade-offs, I know, but we have to find responsible ways to reign in our health care costs and use the money we DO commit to the best possible use.

Every dollar we spend in futile denial of inevitatble death and without even any increase in a patient's quality of life -- in fact, just the opposite -- is a dollar we are stealing from those who need it.

Provactively put? Yes. True nevertheless? Also . . . TRUE.

 

[CADsortaGUY]

How old are you perk? Be sure not to run your "costs" over that magic limit...

 

[alchemize]

Glad to see you are coming around to my view on healthcare Perkie - been saying this for years and called a heartless bastard End of life costs will skyrocket as the baby boomers go into retirement. We love you grandma and grandpa/mom/dad (myself someday), but you really don't want to go out like that, and neither do we.

 

[Budmantom]

With UHC end of life costs will be a thing of the past just wait in line and we will get to you when we can.

 

[Perknose]

Originally posted by: CADsortaGUY
How old are you perk? Be sure not to run your "costs" over that magic limit...

Totally non-responsive diversionary appeal to emotion, and a lame one at that.

 

[Perknose]

Originally posted by: alchemize
Glad to see you are coming around to my view on healthcare Perkie - been saying this for years and called a heartless bastard End of life costs will skyrocket as the baby boomers go into retirement. We love you grandma and grandpa/mom/dad (myself someday), but you really don't want to go out like that, and neither do we.

I have always been there, al. It's a big island. Want a coconut?

 

[winnar111]

Just cap medical costs at 10x salary per year. Then youre on your own.

 

[RocksteadyDotNet]

Originally posted by: Budmantom
With UHC end of life costs will be a thing of the past just wait in line and we will get to you when we can.

I can see you don't live in a country with UHC.

You just keep being ignorant.

 

[Brainonska511]

Originally posted by: Budmantom
With UHC end of life costs will be a thing of the past just wait in line and we will get to you when we can.

So we should only care about people that are nearing vegetable status and those that aren't yet born? Anything in between we'll throw under the bus.

 

[CADsortaGUY]

Originally posted by: Perknose

Originally posted by: CADsortaGUY
How old are you perk? Be sure not to run your "costs" over that magic limit...

Totally non-responsive diversionary appeal to emotion, and a lame one at that.

wow, way to be a prick. I stated that in semi-jest but it's backed by the reality of implementation issues.

I happen to agree that we try to keep people around too long - i just don't think it's something the gov't should be limiting.

 

[Mani]

Really interesting point you bring up. I think medicare/medicaid in general are probably the programs in most dire need of overhaul in this country, but due to the retiring baby boomers and massive voting population amongst the elderly, the issue is kryptonite for politicians. Just don't see this ever being addressed unfortunately.

 

[heyheybooboo]

Do it.

1) Write a living will; and
2) Establish a health care power-of-attorney.

(and keep them updated)

Don't do a 'slacker' version of a living will. Those single- or two-page documents don't cut it. Most hospitals and doctors will not recognize a 'DNR' without a description and explanation. The greater the detail and description the better. Use a template - there are a bunch of them around. Good ones will describe each level of care you desire in definitive circumstances if you are incapacitated. Discuss it with your family and explain to them it's in everyone's best interest in times of incredible stress and that it represents your wishes. Keep it updated as your personal and family situations evolve (and medical technology changes).

A health care power-of-attorney can really work to your advantage. I can go either way on this one - I put a really close friend in charge but some folks will use a family member. Specifically hold them harmless and relieve them of any liability.

The problem (as I see it) in using a family member is that conflicts always seem to arise before and after the 'fact'. The politics of 'family' may exceed that of P&N - stress and emotion between family members can cause poor decision-making with regard to the living will (""Oh, Mommy, you can't let Daddie die!).

 

[Genx87]

Honestly I am surprised it is only 1/3rd. The number I remember reading somewhere said 80% of a persons medical costs are incurred in the last 2 years of their life.

 

[dullard]

We need to change our attitude. Right now, American's as a whole have the mentality of "Extend life at all costs, including monetary and quality of life costs". Sorry, but it just isn't worth it to have multiple operations to extend life by a few more weeks. Those last few weeks are usually filled with pain and the best we can do is dope you up with drugs and send you off to a hospice. You'd probably be better off without that medical care.

I've been called cold and heartless. I think it is just the opposite. A little more low quality life isn't beneficial to ANYONE. It just prolongs pain and suffering for the person dying. It just prolongs agony and sadness for the relatives. The best thing for both parties, is to let nature run its course.

That and triple the number of trained doctors. That'll make them far less overworked and will cause their salaries to plummet to a point where medical costs are not very expensive anymore.

 

[Moonbeam]

Originally posted by: dullard
We need to change our attitude. Right now, American's as a whole have the mentality of "Extend life at all costs, including monetary and quality of life costs". Sorry, but it just isn't worth it to have multiple operations to extend life by a few more weeks. Those last few weeks are usually filled with pain and the best we can do is dope you up with drugs and send you off to a hospice. You'd probably be better off without that medical care.

I've been called cold and heartless. I think it is just the opposite. A little more low quality life isn't beneficial to ANYONE. It just prolongs pain and suffering for the person dying. It just prolongs agony and sadness for the relatives. The best thing for both parties, is to let nature run its course.

That and triple the number of trained doctors. That'll make them far less overworked and will cause their salaries to plummet to a point where medical costs are not very expensive anymore.

You don't think the number of doctors isn't artificially limited for that reason?

 

[Mursilis]

Originally posted by: Perknose
Ok, these are tough questions and tougher trade-offs, I know, but we have to find responsible ways to reign in our health care costs and use the money we DO commit to the best possible use.
Every dollar we spend in futile denial of inevitatble death and without even any increase in a patient's quality of life -- in fact, just the opposite -- is a dollar we are stealing from those who need it.

Provactively put? Yes. True nevertheless? Also . . . TRUE.

This is very true and correct, but the tough question is, how? When they dying and the families of the dying are detached from the financial costs of their decisions, of course they're going to want to spend someone else's money to extend the life of a loved one, even if it's only a few more days or weeks. My mom's worked as an RD in various hospitals for 30+ years, and seen it time after time. How do the various propsed versions of UHC address this problem?

 

[nobodyknows]

Originally posted by: alchemize
Glad to see you are coming around to my view on healthcare Perkie - been saying this for years and called a heartless bastard End of life costs will skyrocket as the baby boomers go into retirement. We love you grandma and grandpa/mom/dad (myself someday), but you really don't want to go out like that, and neither do we.

Praytell, how to tell when they are in their "last year" of life?

I have a good way of telling when we've had the last blizzard of the season. It's generally the one after the one you thought was the last. Sometimes it's even the one after that.

 

[dullard]

Originally posted by: Moonbeam
You don't think the number of doctors isn't artificially limited for that reason?

That reason is EXACTLY why people with 4.0 GPAs in college and decent MCAT scores are rejected from medical schools. The doctors want to limit people who get into medical schools. That limits the supply of doctors and drastically raises their salary.

Claim that a limited number of doctors is necessary for public safety, and bingo, the public is behind you. Of course, that claim flys in the face of reality (tired and overworked doctors is NOT the best thing for public safety). I can see good reasons to reject someone with a 2.0 GPA and a failing MCAT score. That would be safety. But highly qualified individuals are rejected daily from medical schools solely to maintain high salaries for doctors.

It is a common tactic. There are many things that require a license simply to increase wages of those who have that license. Legally, I need a license to do simple electrical work such as changing a light switch. That task is so easy a young child could do it with no possibility for messing up. But no, in order to raise the salary of electricians, you have to have a professional do it for $75. Or same goes with professional engineers. A normal engineer graduated from an accredited school and passed all necessary tests to show that s/he has the knowledge to do the work. Then that engineer works for years at a business proving that s/he has the skills to do the work. But to sign a document, you need to pass two more tests. The tests cover nothing that the engineer didn't already prove the ability to solve in college. But, those tests limit the number of PEs and thus raises their salary.