The Choice: A Longer Life or More Stuff

[REWahoo]

An interesting NYT article on health care costs...

The current situation is indeed unsustainable, a point that the conventional wisdom has right. The cost of health insurance can’t keep doubling every seven years, and wasteful spending — the brand-name drugs that are no better than generics, the treatments that haven’t been proved to extend lives or improve health — does need to be reined in.

But far too much of the discussion has been centered on this narrow idea. Somehow, going to the mall to buy clothes has come to be seen as a vaguely patriotic way to keep the economy humming, and taking out a risky mortgage is considered to be an investment in one’s future. But medical care? That’s just a cost.

It’s easy to be against high costs, and it will no doubt be hard to come up with a broad health care solution. But the way to start is by acknowledging that an affluent society should devote an ever-growing share of its resources to the health of its citizens. “We have enough of the basics in life,” Mr. Cutler, the economist and author, points out. “What we really want are the time and the quality of life to enjoy them.”

 

[jeff2006]

This is a serious question. Why is is wonderful to spend money on gigantic houses and vehicles, exotic travel, stupendous weapons, and so forth, but bad to spend on health care?

 

[eridanus]

This is a serious question. Why is is wonderful to spend money on gigantic houses and vehicles, exotic travel, stupendous weapons, and so forth, but bad to spend on health care?

Because the US spends more and receives less?

 

[MasterBlaster]

This is a serious question.  Why is is wonderful to spend money on gigantic houses and vehicles, exotic travel, stupendous weapons, and so forth, but bad to spend on health care?

In a nutshell, the article implied don't spend money on gigantic houses and vehicles, exotic travel just for yourself.

Spend your money on healthcare for everyone.

What did you expect from the NYT ?

 

[Leonidas]

Interesting article. It caused me to do some reading to try and form an opinion. What I found is that I still haven’t made up my mind, but there are some interesting facts in support of, and countering, what Leonhardt wrote.

But the way to start is by acknowledging that an affluent society should devote an ever-growing share of its resources to the health of its citizens.

Seems that we have been doing exactly that. According to a CDC report:

In 2003 the United States spent 15 percent of its Gross Domestic Product (GDP) on health care, a greater share than any other developed country for which data are collected by the Office of Economic Cooperation and Development.

But we are paying out of pocket for an increasingly smaller share of medical costs and shifting the burden to others.

Overall, private health insurance paid for 36 percent of total personal health expenditures in 2003, the Federal Government 33 percent, State and local government 11 percent, and out-of-pocket payments paid for 16 percent. Since 1980 the share of total expenditures paid out-of-pocket declined by 11 percentage points (Health, United States, 2005). This decline resulted from an expansion of benefits in both private health insurance plans and in government programs.

I’m not sure if this supports Leonhardt or refutes him. On the one hand it could say we, as a society, are paying more for health care. Or, it could be saying we’re letting someone else pay more for it.

As for life expectancy gains, is it accurate to say that it is all due to better health care? What about genetics, race, geography, income, diet, exercise, climate, etc.? What about evolution? Are we living longer because natural selection has produced humans that “…are able by virtue of their defenses or lifestyle to live for long periods whilst avoiding accidents, disease, predation etc. (and) are likely to have genes that code for slow aging- good repair”? I look at this chart and see different levels of life expectancy based on geography (and race/ethnicity to some extent) which may be due to health care level available in those areas. But, I also see that, with the exception of the sub-Saharan, have risen nearly in unison. Are they all spending increasing amounts of their GDP on healthcare?

Leonhardt sounds like he's saying that money spent on things he approves of is money well spent. Even though the facts don't necessarily support his argument that more money would produce significant results. On the other hand he also seems to be saying that money spent anywhere else is just because of our rampant greed, stupidity and blatant consumerism. I wonder how much Dave Leonhardt's house cost, or how often he trots into Old Navy for some tasteless clothing.

 

[modlair]

The reason there is a problem with this is an absence of solid data showing that longevity, at whatever quality, is affected profoundly by increased healthcare expenditure.

In other words, the metric to measure bang for the buck, though at some point "quality of life" is involved, is longevity. If there's a failure of performance on that metric, then that's a failure.

This was discussed this week on another thread. Increased life expectancy over time is mostly affected by elimination of childhood diseases. There is no evidence that healthcare expenditures later in life are adding time. In fact, it is inevitable that such a measure fails to show anything significant simply because the expenditures are so very high in the last week of life. Those dollars get no return to speak of because the guy's time was simply up.

 

[farmerEd]

Problem with the article, it implies that more spending results in more life...it simply doesn't. US spends more, and gets less for their dollar.

But hey, we managed to tie with Cuba on life epectancy and we only had to spend about 50 times more per person than they did - must be why we have "the greatest health care in the world".

 

[Leonidas]

That's an interesting chart.

And I think the dollar figure for the US may be a little low, I thought our per capita costs were over $5,500.

Raises questions in my mind like: Why are we 29th in life expectancy but pay so much more than everyone else? Do we lead unhealthy lifestylfes and we're just throwing money at healthcare so we can live as we please for a long time?

 

[jeff2006]

The point is that every kind of spending in the US is considered to be good simply because spending drives the economy. Spending on complete trash is good, because it advances the economy, even if the trash is from China. Spending on trash removal is good, because it advances the economy. Has nothing to do with the merits of the product or service spent on. Spending, per se, is generally thought to be good, because it advances the economy.

Except for health care, which provides good jobs for a huge number of people, earnings for shareholders in some cases, big salaries for some segments of the workforce, and so on. So why is this, too, not good? Would it be better to aspire to 9,000 pound vehicles in every garage, and every garage attached to a 15,000 square-foot house? How about a 55,000 square-foot house for every American? These would drive the economy too. But why would they be inherently better than spending on health care?

 

[Rich_by_the_Bay]

I think reasonable people agree that spending on health care is appropriately a high priority.

Problem is value. Unlike consumer items where you can shun them if you feel the value isn't there, health care often has a way of roughly intruding on your life when you least want it, and forcing you to make fast choices with serious consequences. No real competition, and little ability to make truly informed choices unless you have an outstanding primary care doctor.

So you pay a fortune, hope for the best, and wonder if you did the right thing. Not comfortable.

 

[farmerEd]

The point is that every kind of spending in the US is considered to be good simply because spending drives the economy. Spending on complete trash is good, because it advances the economy, even if the trash is from China. Spending on trash removal is good, because it advances the economy. Has nothing to do with the merits of the product or service spent on. Spending, per se, is generally thought to be good, because it advances the economy.

Except for health care, which provides good jobs for a huge number of people, earnings for shareholders in some cases, big salaries for some segments of the workforce, and so on. So why is this, too, not good? Would it be better to aspire to 9,000 pound vehicles in every garage, and every garage attached to a 15,000 square-foot house? How about a 55,000 square-foot house for every American? These would drive the economy too. But why would they be inherently better than spending on health care?

The difference is, that if you aspire to a 55000 sf house, and if you spend money on it, at least you get a 55,000 sf house to live in, which presumably adds value to you, buyer. In the US, we spend more money on health care, and live shorter lives. Who in the right mind would advocate spending more, and getting less in this scenario?

 

[MasterBlaster]

The chart is interesting. However the curve on spending should reflect the cost of providing that healthcare in each country.

Perhaps a better spending metric would be percent of GDP spent on healthcare. In that case the US would still be high but not 10-15 times what Cuba, for example, spends to acheive similar lifespan outcomes.

Also, because of the high consumption of illegal drugs and associated infant mortality and also gun and other violence in this country, the US average lifespan is brought down. While I am sure that the lifespan statistic is correct, I suspect that for US upper middle class people who are somewhat removed from the drug/gun-violence scene that the lifespan is considerably higher than the average indicated in the chart.

So, I suspect that for people who are reading and participating in this forum that the lower US lifespan statistic is not really appropriate and very very misleading.

 

[jeff2006]

But where does the money go that is overspent on healthcare? Goes back into the economy, I guess. Not necessarily bad by conventional reasoning, which includes all kinds of economic activity in computing GDP. Most spending in a consumer culture is wasteful -- but it keeps people employed, keeps the wheels of commerce turning, etc. Stop all wasteful spending and the US will have a depression like never seen before. Must depend on whose ox is getting gored (i.e., where in the economy the money is flowing to).

 

[Leonidas]

Also, because of the high consumption of illegal drugs and associated infant mortality and also gun and other violence in this country, the US average lifespan is brought down. While I am sure that the lifespan statistic is correct, I suspect that for US upper middle class people who are somewhat removed from the drug/gun-violence scene that the lifespan is considerably higher than the average indicated in the chart.

I’m not sure that is the case. Homicide ranks 15th on the list of causes of mortality in the U.S.- 17,723 out of 2,448,288 deaths. That number is for all homicides - not just by firearms. It's less than what Parkinson’s kills each year. Half of suicides, and less than 3% of the deaths caused be either heart disease or cancer. Drugs must be in the all others category, which makes it smaller than homicide. I'm not sure how alcohol or drugs would be counted if the figures were broken down to show them as contributing causes to other causes of death.

 

[mickeyd]

Longer Life will always trump More Stuff won't it?

We all want both, but many of us can only have only one of them.

Which to choose though?

"Ok shoot me in the head now, but promise me a total real return of 45.4% and a new Lexus."

Wait a minute...ahhh...maybe I will opt instead for the option of living for 365 more days.

That will be guaranteed...right?

 

[Gone4Good]

Problem with the article, it implies that more spending results in more life...it simply doesn't. US spends more, and gets less for their dollar.

But hey, we managed to tie with Cuba on life epectancy and we only had to spend about 50 times more per person than they did - must be why we have "the greatest health care in the world".

From this evidence I wouldn't necessarily conclude the problem is with our healthcare system.

U.S. citizens, on average, are the fattest and most sedentary people on the planet. I'm sure poor health habits have a lot to do with our overall poor health and high per-capita healthcare spending.

 

[wabmester]

U.S. citizens, on average, are the fattest and most sedentary people on the planet.  I'm sure poor health habits have a lot to do with our overall poor health and high per-capita healthcare spending. 

Overweight Americans Weigh Down Insurance System

Medical researchers, writing in Health Affairs, compared the money spent treating obese patients in 1987 with the amount spent in 2002. They found an increase from $3.6 billion to $36.5 billion. That means nearly 12 percent of all health care spending in 2002 is now directed at patients who are severely overweight.

Somehow, I suspect other western nations will catch up with us in this regard.

 

[UncleHoney]

What ever happened to the term "major medical insurance"? When I was a kid I know my parents had medical insurance but it was something that only got used when you were hospitalized with big time problems. Everyday visits to the see a doctor weren't covered by the typical medical insurance, neither were shots and prescriptions.

Look at what gets covered today and the number of people involved in delivering medical services. It's big business and making big time money and very little of the expense helps anyone live another day longer.

Back in the early 50's, when I was a kid, you went to the doctor once or twice a year the only people you saw was the doctor and nurse. Today there are more people to process your insurance claims than it took to deilver the medical services of the 50's. They even have a special person to collect your copay.

When I went to the dentist there was just me and the dentist, no hygienist, no assistant, no receptionist. And your mom and dad paid the bill, there wasn't any dental insurance. The dentist cleaned your teeth, filled your teeth and answered the phone too. Today my dentist has three other people in the office, a hygienist, an assistant, and a receptionist running the front desk and processing the insurance claims.

Today you get very little "bang" for your health care buck. Most of it goes for background noise.

 

[dwk]

There are a number of studies that show the healthcare expeditures in the US are several times higher than other industrialize countries with no realized benefit. Here's an interesting article on end of life healthcare expense;http://scholar.google.com/url?sa=U&q=http://ajrccm.atsjournals.org/cgi/reprint/165/6/750.pdf

A large percent of healthcare expense is spent during a person final 12-18 months. At some point there needs to be a change in the delivery of care -- or more precisely -- the withdrawal of care. I've worked in healthcare for 30+ years -- I've seen the pain and suffering caused by last minute heroics -- the false hope. While there are miracles -- the reality is they don't happen very often.

I don't want to live to be 100. I don't want to bury my children. I don't want my estate to be consumed by last minute heroics. Quality of life is important, not longevity. For me the critical age point is 65. As I approach that target and I have my health great. If my genes, life style catches up with me -- and I develop a debillating illness, we'll have a great big party, say good-bye one last time... and continue the journey.

I have a lot in my life to thankful for... a lot of things I still want to accomplish...I have faith I'm going to a better place. I'm 52 now and have lived longer than my dad and both granddads, I'll probably be the first male in my family to enjoy the spoils of retirement. I'm thankful everyday that I get up, but understand my ticket could get punched any time.

dwk

 

[Khan]

A large percent of healthcare expense is spent during a person final 12-18 months. At some point there needs to be a change in the delivery of care -- or more precisely -- the withdrawal of care. I've worked in healthcare for 30+ years -- I've seen the pain and suffering caused by last minute heroics -- the false hope. While there are miracles -- the reality is they don't happen very often.

H*** yes.

I read of bypass surgery for 80 year olds, feeding tubes and respirators for Alzheimer's patients...

My neighbor down the street died last year at 82. She died in a friend's car on the way to chemo for lung cancer (she never quit smoking).

I have a great fear that some self-righteous yahoo will insist on keeping me 'alive' while virtuously denying me sufficient painkillers.

 

[Nords]

Well, I think Scientific American just identified some of the objective criteria on my quality-of-life scale: "Study: Meals out of reach for many older patients".

"WASHINGTON (Reuters) - Many elderly hospital patients may suffer from malnutrition simply because they cannot get to their food and nurses are too busy to help them, according to a study by two Australian researchers.
Helen McCutcheon, head of the School of Nursing and Midwifery at the University of South Australia, and colleague Chenfan Xia observed mealtimes in an acute care facility and found that one fifth of the 48 patients aged 65 and older could not reach food brought to their hospital rooms.
More than half could not open food packaging and more than a third struggled with cutlery. Others complained they were not sitting up properly to eat, and many struggled to pour beverages.
Malnourishment is common among older patients, with 60 percent becoming more poorly nourished while they are hospitalized, Xia said in a statement."

While I normally like to see larger sample sizes in studies, I'm willing to take this one at face value...