America can afford to spend more on healthcare?!?

[Nords]

I'm always nervous when economists & journalists start practicing medicine, even Christopher Farrell.

Farrell claims that (1) When it's your own health, we all quit our whining about healthcare costs and want the best we can find, and (2) Healthcare improvements have paid off so big in longevity that businesses should be willing to pay for all the (potential) extra worker productivity.

I can agree with the first (even though one is a financial decision and the second is rarely anything other than emotional) but I'm cynically suspicious of the quality of the data used for the second claim.

Besides, if we're extending lifespans then why don't people just enjoy a longer retirement? Oh, right, their healthcare costs have risen so much that they actually have to work for twice as long as the longevity benefit.

http://www.businessweek.com/bwdaily/dnflash/sep2004/nf20040927_5435.htm

This Business Week article requires registration but I don't think you have to be a subscriber to the paper version.

 

[ESRBob]

Re: America can afford to spend more on healthcare

Nords,
I'm no expert on healthcare, but that never stopped me posting yet!

Seems to me that most of us will respond to price incentives on all the little stuff -- the trip for the flu or eczema or to have a wart frozen off -- possibly agreeing to schedule things at times more convenient to the doctor in exchange for a lower fee, or groupng non-urgent things together to avoid a second 'trip', if it will put $ back in our pockets (and I'm not just talking about saving a $10 copay!). Likewise we'd take generics happily in many cases if it was going to save us $.

But, if it is something grave and life-threatening -- you've just been diagnosed with a malignant tumor in your stomach or whatever -- then I do think we would rapidly become price insensitive, as long as there is a decent shot at saving your life and/or extending it by a large number of years.

Go one notch further, though, to the no-hopers on their last months of life, and most people (and loved ones, after some soul searching) would choose in many cases, not all, to bypass some of the heroic high-cost, high-wire-act procedures that have little or no benefit, if they felt the pinch of the costs. Right now, these are ' free' to the family and it is easy to say, "Gee, we owe it to Dad to do everything possible to save him", when in fact there is no hope of doing more than giving him a couple extra weeks or months in the ICU. This is where a huge amount of health care spending goes, essentially, down the drain.

It is worth noting that the national health services (e.g. UK) ration this sort of geriatric or final-days healthcare, containing costs and proving that these decisions can be made objectively. Want that last ditch pancreas transplant for dear old Dad? Pay for it personally. Maybe we need a health insurance option that is made affordable because it applies a set of rules that stop short of the heroics -- you know the limitations when you sign up for it, and if youwant to do the heroics at some point down the road, you get out your own checkbook. Is this already available in some form?

ESRBob

 

[John Galt]

Re: America can afford to spend more on healthcare

I had an uncle who was so ugly the doctor stuck his finger in the wrong end

John Galt

 

[cute fuzzy bunny]

Re: America can afford to spend more on healthcare

Its true that the majority of health care costs are expended in the final (and obviously unsuccessful) year of life.

My wife deals with it every day at the hospital. People with very aged parents or badly injured family members who insist that 'everything' be done to keep them alive one more day. Even if they're in severe pain, are brain damaged, will never regain consciousness, or have no long term prospects.

I dont know if asking them to pay the costs out of pocket solves this. Its more emotion than financial.

 

[John Galt]

Re: America can afford to spend more on healthcare

My wife's employer (nursing home) has begun a program to get people
"active" (out of bed, eating, socializing, etc.)
I'm sorry, but a 98 year old woman with multiple
health problems probably has a body screaming to
just be left alone. We should consider that inactivity may be natural, and anyway nature will win out.
Why make her miserable while she waits?

John Galt

 

[trumpeting_angel]

Re: America can afford to spend more on healthcare

End-of-life care is so expensive, eating up a huge portion of our health care costs. And to what purpose? I recently accompanied my younger sister down this path, watching as her cancer (discovered very late) took over rapidly, growing faster than they could operate to take it out. Within a couple of months her mind started to go, and her vision, and her pain was awful to witness.

I stopped the heroic measures before they could get going, even though she was only 47 years old. The offer on the table was more diagnostic tests (painful ones, some of them) in order to determine which awful chemo to use, which MIGHT slow or stop the growth of the tumors (40% chance of slowing or stopping) long enough for them to discover a cure. NO THANKS!

My sister valued her dignity greatly, and despised needles, pain, and loss of privacy. She was psychologically completely unable to make decisions about this, but she put those decisions into my hands very early in the process, with clear indications that I should do what I thought was best and not discuss it with her! Her pastor asked me, What do you think Barbara would want? To suffer less, or to struggle on with faint hope of a cure? And I replied, Barbara would want NOT to have cancer. And that was the only answer. She couldn't cope with anything beyond that.

Some people would find my decision process hard-hearted, I suppose. But I was convinced that she was going to die, and I loved her enough to let it happen as pain-free as I could.

I think we are all too weird about death in this country. If we could accept the fact that we are going to die, sometime, maybe we would live richer, fuller lives instead of chasing material accumulation. And maybe we'd be willing to let it happen instead of fighting it off with painful treatments, surgeries, and machinery, wasting our health care dollars while the working poor don't have coverage for the basics.

Wow, what a mood *I* am in! I saw the doctor today for a full, mega-workup (and cancer prevention plan) and got a clean bill of health! "You may be 51, but you have the body of a much younger woman." HAH!

Anne

 

[John Galt]

Re: America can afford to spend more on healthcare

Hello Anne! Sad story about your sister. I think you handled it well. Hope it inspires some serious thought among the ER
family. I was tempted to pontificate on death and dying
but couldn't match your first hand up close and personal account.

Your comment about "you have the body of a much younger woman" made me wonder how many on this board get regular medical checkups. I never have in my life and won't start now. In my case, it only leads
to discoveries I believe I would be better off not knowing. I know preventive medicine can save lives,
but it can also give you a bunch of stuff to worry about
and much of what ails us can't be helped by modern
medicine anyway. I have gotten to a point where
(like my father) I just try to avoid doctors altogether
and hope for the best. My wife is the same. Anyone
care to weigh in?

John Galt

 

[ESRBob]

Re: America can afford to spend more on healthcare

TH - my logic was that although asking people to bear the cost for the heroics wouldn't necessarily stop them choosing to go there, it would help ease the burden of these (usually futile) high cost procedures for the rest of us in the same insurance pool.

For a few more practical healthcare cost-saving options I'd like to see:
a) a way to waive my right to sue (malpractice) and thereby save money on my healthcare spending. I would then be incentivized to find a good doctor and monitor what they are doing, but every illness wouldn't start to feel like having a shot at playing malpractice lotto.
b) a way to walk-in to see a nurse practitioner instead of a doctor and get inexpensive healthcare quickly and cheaply. (We had this at the college health service at UC Berkeley when I was an undergrad there, and it was cheap, convenient and effective -- always wished I could get back to that system again). But even an appointment-based approach to nurse instead of doctor (referred on to the doc, of course, if warranted) would be an improvement over the long waits to see only the doctor.
c) an insurance plan that explicitly exempts end-of-life heroics from your menu of services, and costs meaningful amounts less.
d) self-insure for all but major/catastrophic/accident, and get a discount from the doctor (not premium as most non-insured people pay now!) for paying cash, perhaps coupled with waiving my right to sue for malpractice. I would become the responsible health care consumer, checking out the doctors quality, reputation, staying fit, maintaining myself much the way I take care of my car with quality mechanics now.

Finally, I'll never get over the suspicion that for lots of working stiffs, regular visits to a doctor for some 'condition' or another is about the only way they can ever get some time out of the office and a break from the tedium, payed for by 'the employer'. Sad, but I know it happens. My guess is that happy people (whether ERed or happily employed or whatever) may find themselves healthier, on average, than the miserable office worker feeling imprisoned in a job.

ESRBob

 

[Cal]

Re: America can afford to spend more on healthcare

a way to waive my right to sue (malpractice) and thereby save money on my healthcare spending

I will happily waive this right if a better system was designed to reprimand/punish incompetent doctors. I agree that far too many people use this as a "lottery" and that practice needs to be stopped. I can't stand that doctors police themselves (in a disciplinary hearings) and that this is regulated at a state level. Someone barred from practicing medicine in one state can pick-up and set-up shop in another state.

Finally, I'll never get over the suspicion that for lots of working stiffs, regular visits to a doctor for some 'condition' or another is about the only way they can ever get some time out of the office and a break from the tedium, payed for by 'the employer'.

Had to really smile at this one. A couple of years ago, I had to go into the dentist office because a tooth broke. I was laying back in the chair perfectly calm and relaxed as he was checking the tooth, taking xrays and did some drilling. He commented that he had never seen a patient so relaxed and calm with a broken tooth. My honest response was: "it's much better than being at work."

 

[trumpeting_angel]

Re: America can afford to spend more on healthcare

John, thanks for your kind words.

This is my first physical, actually, in recent memory. But I'm on a cancer prevention hunt, and it's giving me some peace of mind.

Just one other thing that jumped out at me: ESRBob, that insurance policy that didn't pay for heroics would have to be pretty well thought-out for me to sign on. Having seen the shenanigans that they pull with trying not to pay for plenty of other covered services, I'd hate to have some insurance clerk (or exec, especially!) decide what was "heroic" for me. It would need some careful thought, some clear language, and unfortunately, some regulation from the government, I think. I know far too well that you can't trust these people.

Anne, just back from Minneapolis

 

[John Galt]

Re: America can afford to spend more on healthcare

Hello Anne and ESRBob........

Regarding "heroics" and healthcare, I am much too lazy
to read through our healthcare policy. We are quite satisfied so far, but I believe the way they hold our premiums down is that everything has a fixed set
benefit amount and a cap. I doubt that heroics are covered to any great extent, but we are okay with it
as we feel we are getting value for our premium dollars.
With insurance in general, I have often felt otherwise.

When my aunt had cancer (age around 69 I think)
she told them to skip the chemo and just make her comfortable.

John Galt

 

[ESRBob]

Re: America can afford to spend more on healthcare

 ESRBob, that insurance policy that didn't pay for heroics would have to be pretty well thought-out for me to sign on.  Having seen the shenanigans that they pull with trying not to pay for plenty of other covered services, I'd hate to have some insurance clerk (or exec, especially!) decide what was "heroic" for me.  

Anne,
I agree that it would need to be well-thought out and well-documented.  Making huge new loopholes to help them avoid paying out on legitimate claims would be no good.  Still, we've worked on harder stuff as a society!  And if you wanted to be assured of medical gold-treatment (and importantly to be in a pool with others, possibly quite elderly, who were also going to be assured of the gold treatment) you could always have the more expensive premium and better policy.  The cheaper one would be for people who self-select, based on their feelings (rightly or wrongly) about their good health prospects, good health habits or philosophy about heroic western medicine measures (or plain old economic need), and thereby save meaningful $ here and now.

You could always opt to pay fee-for-service when push came to shove, and you realized you were wrong -- it wouldn't be insurance then, of course, but it might still work out cheaper over the long haul...

ESRBob

 

[trumpeting_angel]

Re: America can afford to spend more on healthcare

I find myself thinking about it since you proposed it. There ARE honest insurance companies, but many, many of them have behaved absolutely disreputably during the health care cost crisis (while making obscene profits and paying their CEO's staggering salaries).

And the only way I can imagine it being safe is with boatloads of regulation. Bummer.

I had Kaiser HMO in Massachusetts in the early 80's. I was mostly healthy and mostly happy with my treatment. It wasn't until costs started skyrocketing that managed care began to be unethical, although others were unhappy with Kaiser before that, too. I had absolutely wonderful doctors.

Anne

 

[Billy]

Re: America can afford to spend more on healthcare

Anne, I agree with you on your comment on how we view death in this country. We are all going to die at some point and we don't know how or when. If we fully accept that fact, I believe we would live differently; make different choices in most categories of our lives. This would include how we spend our time, who we choose as partners in life, whether or not to hang onto grievances, what we do for work and how we spend accumulated wealth, to name a few.

I accompanied my Mother through a conscious dying process (Cancer). The certainty of death allowed her to live her life with tender, creative flourish until the very end. You can read about her and this experience on our website in the article called END OF LIFE CARE.

Thanks for your comments on this mostly taboo subject.

Gratefully,
Akaisha
Website: www.geocities.com/ba264

 

[trumpeting_angel]

To Akaisha

Akaisha,

Your mother was such a remarkable woman! Her death contrasts so much with my sister's. My sister married at 40, and 1 1/2 years later lost him, to cancer. He was only the second love of her life, I believe, and she was devastated. She never fully recovered from his death.

She was unable to accept her own death, except at moments. I cried and cried when I found on her computer instructions she had left for me. She only managed about one paragraph, then the project was abandoned; I don't know if it was due to pain, painkiller fog, or her inability to face it for more than a moment. My sister's level of denial and willingness to not-know was legendary in our family. At first, I thought it would make it impossible for me to be with her during her dying.

Oddly, it was just the opposite. As a psychologist, I'm comfortable with allowing people to act like they don't know some things, with allowing them a certain level of denial. She didn't want to know, and who among us can blame her? She was only 47, had never had any children (one of her lifelong goals). She and I were very different: she was conservative, proper, sociable, and wealthy. I am liberal, somewhat reckless and unwilling to accept some of society's "rules," a little bit shy and bookish, and not very wealthy (until I inherited from her). I always worked more for love than money.

We discovered that, although we had almost nothing in common and indeed, didni't LIKE each other all that much, we loved each other dearly. We BOTH knew that, whichever of us truly needed, the other would be there. So I was there. And she would have been for me.

So your mother's death is filled with wonderful life lessons! My sister's was, for me. I miss her.

Anne

 

[Michael]

Re: America can afford to spend more on healthcare

I know preventive medicine can save lives,
but it can also give you a bunch of stuff to worry about
and much of what ails us can't be helped by modern
medicine anyway.

I go every year. There are some things that are easily cured if you catch them early, but can become nightmares if you wait too long. I will risk finding out about something that can't be cured by meds. I can always pray to the Lord about these. Perhaps He will have mercy on me, and heal me.

 

[indymom]

Re: America can afford to spend more on healthcare

My husband is recovering from surgery for prostate cancer and should make a full recovery. It was found by a routine PSA test taken during a blood pressure evaluation. He had no symptoms and the ultrasound came out OK also. The biopsy didn't. Symptoms usually come when it is too late.

 

[John Galt]

Re: America can afford to spend more on healthcare

Hello indymom! Hope your hubby makes a fast recovery.
Was there any history of prostate cancer in the family?
I have been told that is frequently the case.

John Galt

 

[indymom]

Re: America can afford to spend more on healthcare

JG, thanks for the kind words. Actually, the only prostate cancer was in relatives old enough that apparently most men have it and it moves so slowly that it doesn't make much difference.

He is 59 and probably wouldn't have gotten the PSA if he didn't have to keep track of his blood pressure meds. The MD did the PSA while he was at it.

He is recovering well, altho the staples (!) used to close the incision are beginning to bother him. He will know more this Thurs. when he makes a return visit to the surgeon. There will be a path report with info about lymph nodes and such. Hopefully all negative.

 

[Zipper]

Re: America can afford to spend more on healthcare

The research is saying that all us elderly males have small very slow growing prostate cancer cells that will not endanger our lives. We will most likely succumb to something else 20 years down the line. We need to eliminate fatal fast growing prostate cancers without question, but again, the research is showing that these aren't all that common. Watchful waiting if one is found, rather than whip out everything and risk incontinence and/or impotence seems prudent.

 

[John Galt]

Re: America can afford to spend more on healthcare

Well. although I am only 60, I would opt for watchful
waiting unless I was convinced my demise was
imminent. Maybe even then. I have been through
the treatment options with friends who were afflicted.
Not really interested.

John Galt

 

[Beachbumz]

Re: America can afford to spend more on healthcare

Can somebody please explain why I can order a prescription drug from Canada, that has to be purchased from New Zealand (because it is Lipitor and Phizer has cut shipments to Canada...my Dr was perfectly fine with this, even re-wrote the prescription for 90 days instead of 30), goes through 2 middlemen and is still 50% less (that includes shipping) than I can get it for 2 miles down the road?

 

[Michael]

Re: America can afford to spend more on healthcare

...still 50% less (that includes shipping) than I can get it for 2 miles down the road?

The same reason hearing aides cost $2000 instead of the $100 the inventor says they should cost. Our politicians grant monopolies on who can dispense the stuff. Monopolies can charge what ever they want to. Pay it or die.

 

[indymom]

Re: America can afford to spend more on healthcare

Exactly