Comments on: Medicare and the deficit A slice of lime in the soda Sun, 26 Oct 2014 19:05:02 +0000 hourly 1 By: TFF Sun, 14 Nov 2010 00:59:42 +0000 hsvkitty, only y2kurtus can speak to what he meant by “quality and purpose of those additional years”, however consider the following study from 2002:  /PMC1464043/

“From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death.”

While the costs have increased over the last 15 years, the balance appears to be similar. A more recent article estimates that 27% of Medicare goes towards last-year-of-life care.

Most intriguing, there appear to be metropolitan areas that aggressively treat the dying in the ICU while other cities are more likely to go with hospice care (at half the cost). Frankly, I hate hospitals — hospice treatment sounds more attractive in my final months (even if I don’t “live” quite as long). That might have been what y2kurtus was talking about?

By: hsvkitty Sat, 13 Nov 2010 21:38:54 +0000 @ y2kurtus OUCH!!

As someone about to turn 57 that sounds pretty harsh. TFF is right. It matters not what you think at 62 if the youth are going to abandon ensuring you are cared for. Maybe 50 will once again be too old? It wasn’t that long ago that 30 was over the hill!

We are the baby boomer generation and there will be a lot of new legislation and changes because it was such a growth period in a short span. When we are all gone, will those younger then you feel less kindly towards the elderly (such as your kids) having heard your generation speak harshly of the aged as they grew up?

Hopefully the decisions made will be with care and forethought because afterthought usually means people suffer.

I know many people retired who are busier now then when they worked and many volunteer hundreds of hours in a month. My 88 year old Dad still gardens a half acre by hand. Not even a rotor tiller. So who will decide whose quality of life and what age might deserve to be extended?

Business has no business being involved in health care. You may end up with a 2 tier system. but whatever happens, it will have to be tweaked many times and so it should be to remain efficient. Our Canadian system was also shunned, but few complain now.

It works and when it doesn’t it gets tweaked, because we all see the benefit and are willing to pay (less then you all do ) for Universal healthcare. It needs an overhaul as well due to the same baby boomer/ technology updating problems you will encounter, but we will still pay less then Americans in per capita costs.

An efficiently run system (if it ever gets to a place where it can be efficient and that does mean Government /state run) will take the burden off medicare by making it work for the people, not the shareholders and the Capitalist machine.

If 20% of premiums goes to profit of your insurance company before health coverage and yet you make such a statement about the elderly, everyone best hope that train of thought isn’t on the main track.

By: TFF Fri, 12 Nov 2010 22:30:43 +0000 y2kurtus, it matters little how you feel when you are 62. What matters is how the 32 year old workers feel when you are 62. Is why I’m not counting on anything.

By: y2kurtus Fri, 12 Nov 2010 19:34:50 +0000 I belive we are moving to a 2 tiered system of healthcare in the United States (one similar to 75% of the rest of the world.)

The poor and the middle class will get “generic” medicine where they see a nurse practitioner / midwife level of care and can get any medicine so long as it’s on wal-mart’s $4/month list.

Beyond that goverment funded cheap/cost effective system there will be a private payer system where if you want anything truely costly than you need to fund that A. out of pocket directly, B. via extreemly expenceive privatly purchaced insurance, or C. have a community fundraiser where you beg freinds, family, and strangers to support your care.

In healthcare spending emotion dominates the debate in society where mathmatics will eventually rule out. Coldharted though it may seem there is no return on investment in the healthcare of those who have exited the workforce. Spending a few % of GDP to eliminate needless pain and suffering is a worthy goal.

Spending 25% of GDP to artifically extend lifespans without consideration of quality or PURPOUSE of those additional years seems absurd… but then again I’m 32… I might feel differently when I’m 62.

By: habakak Fri, 12 Nov 2010 18:21:03 +0000 The biggest problem is that people DON’T TAKE THEIR HEALTH SERIOUSLY. That’s why we don’t have to know the ‘price’ of an ‘item’ or ‘service’ when we go see a Doctor. We have insurance and it will be covered. Well, we need to move away from that model. If we think that healthcare is just another product, well, then we need to let marketforces do it’s work.

People should be held accountable for their health. The best way to improve that is through education. Based on factors to be determined (for instance sex, age, occupation, gene factors, location, etc) each person should get a annual ‘budget’ for certain expenses. What you don’t use get carried over so that in old age you have accumulated (hopefully) enough credits to sustain your deteriorating health.

Off course exceptions need to be built in for things beyond your control, like accidents for example. It surely is not an easy problem to solve, BUT PEOPLE NEED TO TAKE THEIR HEALT MORE SERIOUSLY AND NOT RELY ON INSURANCE to cure it all.

By: Laumilo Fri, 12 Nov 2010 17:29:25 +0000 Regarding eliminating the “Doctor Fix” in Medicare:

In some areas Medicare fees paid to MDs are so low that, after overhead, there is minimal income for the MD providing the care and taking on the liability of seeing the patient. (see 2:51 EST blog entry)

Consider the position as an MD in practice, who is lucky if her/hid overhead is only 50%. Current plans call for cuts in fees of 21%, reducing the income from a medicare visit by an additional 42%.

It may become economically impossible to accept new medicare patients into a practice
The bottom line for adults: Find a generous good hearted MD who is at least 15 – 20 years younger than you are to be your primary care physician, and good luck getting specialist consultations. The alternative is to have a corporation in charge of your health care. Kaiser appears to be one of the best in this regard.


By: TFF Fri, 12 Nov 2010 14:21:08 +0000 netvet, those proposals sound attractive but none of them are 100% clear-cut.

I personally favor tort reform, but you want to make sure that patients have appropriate recourse in cases of gross negligence. I’m sure the system can be improved, though.

Taxing “fat” sounds tempting, but what exactly are “fattening foods”? Foods that contain fat? Foods that contain carbohydrates? Foods that contain calories?!? Modern nutrional science (peer-reviewed, not Atkins) supports a diet that includes substantial amounts of oils. Whole grain, plant-based diets, rich in fruit and vegetables. In that light, taxing corn chips may be the wrong way to go.

As for the FDA approval process, you ultimately have to decide between safety and efficiency. The Vioxx problems made the FDA reluctant to accept anything without STRONG evidence of safety. I’m happy to reverse that, but understand that many drugs will come on to the market with serious side effects that are not well understood until years later.

While you are at it, make sure you include some protection for the drug companies against lawsuits stemming from those serious side effects.

By: netvet Fri, 12 Nov 2010 14:06:26 +0000 There are three other areas Obamacare did not address:

1. Tort reform to save doctors from exorbitant malpractice insurance, thus driving up the cost of their services – estimated savings: up to $500B annually.

2. Tax fat. If we tax alcohol and tobacco, because they are bad for us, we should tax fattening foods, too. The US spends 1.5X more than any other country on healthcare, yet we rank 30th in overall health, mostly due to obesity. The true cost of obesity in the form of additional diabetes, cancers, heart disease, etc, is the single greatest contribution to our overweight healthcare expenses.

3. Streamline the FDA approval process. Companies have to spend far more on getting approval of safe products in the US than any other country. Many of these products have been approved for years in other countries. As a result, the cost of these products are greater in the US.

By: TFF Fri, 12 Nov 2010 13:35:46 +0000 “The only way to get rid of that silliness is to go to a single payer system.”

I’m guessing that this happens within five years of Obama’s health care bill being fully implemented. By the law of action/reaction (economic version), the changed incentives provided by the law will result in significantly changed behavior — vastly greater costs and lower revenues than expected. As a result, the total cost to the federal government will balloon beyond the CBO numbers at the time the bill was passed.

The good news is that this is likely to be primarily a transfer of costs from the private sector to the public sector. I don’t expect the ACTUAL cost of health care to be increased that dramatically, but people will naturally take advantage of the generous subsidies.

In any case, a tidal wave of people leaving private plans and joining the public plans will naturally push us towards the simpler single-payer system. Seems likely to happen sooner rather than later.

By: Nameless Fri, 12 Nov 2010 13:08:19 +0000 “How much is the gov’t spending on corporate farm subsidies and petroleum subsidies?”

Gov’t spending on farm subsidies averages 0.15% of GDP.