Healthcare and the Supreme Court

[HeyYou]

@grannywils

 

Social security and Medicare are completely different animals. I am very much aware that Social Security is meager in its support of seniors, that COLAs have been way down the last several years--and I am not in support of this. Likely, the best way to increase Social Security benefits is to a) raise payroll taxes to cover it and b) raise the retirement age to 67-70.

 

I stand firm, however, that our federal budget is only so large. To give to one group is to take from another, either by way of direct taxes or by way of changing our budget's priorities. It is also a stone-cold fact that we have not paid for these programs fully over the last thirty years. That is why we presently have an enormous public debt and deficit. Said deficit is being placed on my credit card, though I have known none of the benefits that went into its construction. Likely, I never will either, because our present pace of spending is unsustainable.

 

But rather than make this all about "me," let us broaden the horizon. I refer to said graphics regarding medical inflation and Medicare's increasingly large percentage of our total federal budget and GDP. 18% of GDP in 2080? If Medicare is 23% of the federal budget now--when it is only at 5% (with Medicaid) of GDP--I truly shudder to think of what percentage it will be (85%?) in 2080. That would mean that our nation would pay for medical care for the elderly and young--and almost literally nothing else.

 

Previously (before I redacted it), I had used my grandfather as an example of out-of-control spending in the twilight moments of one's life. I still do not want to use his memory in that way, but suffice to say the cost was exorbitant--and it was also primarily picked up by Medicare. This "bought" him a few more months of life, albeit at a quality of life that I personally would not want for myself. Now, I am sentimental for my grandfather, but I am also real about this. It was by no means an efficient use of scarce taxpayer dollars. Full stop. Such treatment, IMO, should be available in privately purchased plans, not subsidized by the public.

 

Don't misunderstand me though. I am talking about the very end of a person's life, not quibbling about providing care to somebody who is in their 50s or 60s or even in their late 70s. My grandfather was 93. He had had a wonderful life. I am not saying that the government should not have looked out for my grandfather, but only that the government should have only taken him so far. Heartless as it may sound, I agree with Taiwan not providing chemotherapy to nonagenarians. Not when you could be spending it on education, of bringing the next generation into the world. End-of-life care is a huge proportion of our total spending on healthcare. I once read an article comparing our massive outlays purchasing this type of care as the contemporary equivalent of building Egypt's massive burial tombs and pyramids. This in that they are monumental expenditures of our national wealth, yet they serve absolutely zero functional or economic purpose after they are completed. And they represent the death of so many other possibilities, so many other purposes that that wealth might have been better used for. Medicare spends a full third of its annual budget on patients in their last year of life, and over half of its budget on patients in their last two. Source.

 

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget for the Department of Homeland Security or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact.

 

One of her doctors, Ira Byock, told "60 Minutes" correspondent Steve Kroft it costs up to $10,000 a day to maintain someone in the intensive care unit. Some patients remain here for weeks or even months; one has been there for six months.

 

In almost every business, cost-conscious customers and consumers help keep prices down. But not with health care. That's because the customers and consumers who are receiving the care aren't the ones paying the bill.

 

"The perverse incentives that exist in our system are magnified at end of life," David Walker, who used to be the government's former top accountant, told Kroft.

 

Walker used to be the head of the Government Accountability Office. He now heads the Peter G. Peterson Foundation, which is a strong advocate for reducing government debt. He says that 85 percent of the health care bills are paid by the government or private insurers, not by patients themselves. In fact most patients don't even look at the bills.

Source

.

 

Anyway, now it should be clear what I am talking about. If you are reading this, chances are I am not talking about you or your healthcare. I am talking about the terminally ill and the extremely old.

 

I definitely agree with HY when he states that fear of litigation is another massive engine driving up the cost of medical care. I will add that I believe in using the best medical practices to treat a given illness, that exotic or unproven treatments probably should be left to optional private plans purchased before the onset of sickness. Ditto for end-of-life care. I just posted about this in the election year thread.

 

Finally, this is about the budget, which means this is about our government and its priorities. A government is created through politics, which is a bare-knuckles contest over power. Thus, a budget is merely one of many expressions of the power different groups wield within a country. Right now, this should tell you that seniors are winning this contest for power, even if not every senior has realized an equal benefit. But when federal dollars spent on the last two months of medical care are larger than the entire budget of the Department of Education I can tell you very easily who is decidedly not winning in this contest for power. That is the young and their parents, the middle-aged. I do not want to come across as anti-senior, because I am definitely not. This is merely reality. I would like everybody in our country to have an excellent quality of life, but until we actually raise taxes to pay for these things, we will have to make due by taking from one group's budgetary allotment and giving it to another. Or by running up huge debt (which means taking it from ME). End-of-life healthcare means stealing from the future, to make almost a reverse-investment. We are all going to be old and, at some point, we are all going to pass away. It is senseless and wasteful to fight this in order to live a few more unhappy months.

 

EDIT:

 

@Silver

 

I did not mention those living with disabilities because I am not addressing those with disabilities. Please do not input motives to myself or to my posts that are not actually there. I am speaking of end-of-life care. It is barbaric to neglect those with disabilities, no matter their age.

 

And what's really funny is, congress is attempting/has passed a 'tax break' that reduces the social security tax for both workers, and employers. Nice huh. The republicans like to scream that SS is broke, and needs to be revamped, but, they still vote to gut it some more.......

[pseudobio]

Dragging The debate only to the seniors Eh ?

Ya never heard of Eugenics and social Darwinism ?

Well on sukeban's post he avoided the word disabled persons completely and tried to drag it only to the seniors.

Could it be that in sukeban's mind Disabled Persons under a certain age don't exists?

Why for Disabled Persons healthcare is important?

US Current Population Survey of Disabled 2009

U.S. Employment Statistics for Persons with a Disability 2010

Might be Someone find more here

Disabled World

 

Well and in financial dire straits of a government guess witch group has to receive deviantly the 1st front line of those cuts from the government? ( this happen world wide not have heard/seen of any country that doesn't) You don't care ? I guess then you are one of the 85 to 90 % that hasn't a disability in your country.

( World report on disability )

But this can change quickly and it only needs a terrible accident or a severe Illness (cancer is only one of the top of the list and this list is mega long) It can happen very fast or very slow, but it always has a major effect. How much is Healthcare accessible and is always based upon income of yourself or your familial and of social status on the opportunities how to get better or well. Since most long term disabled Persons living with a low income If they have a job and since it isn't well know that disabled are 5 times more likely to be victim of a violent crime ( (easy victims picking by cowards who have a low self-esteem) that needs later medical aid often that requires measures of functional healthcare that defiantly are debated on the backs of the disabled. Include the Disabled in debate and not border them out in healthcare because they are the ones that need most often medial aid on the long run making them bankrupt even trying to get access to medical help . Want to mess with 1 billion of people world wide? ( only for the books China has a population that only 300 millions more ( official census 2010 from china not counting illegal children in china of course)).

Now how nice would it be if they would unite and protest everywhere? Afraid ? Only if Albeism continues on the back of disabled persons. ( It is a devils circle if you are afraid of disabled persons you only continue Albeism by establishing a hierarchy or functionalism or a exchange of power away from the disabled.)

Any one remember the 70's? It already happened once might be it has to happen twice and no nation can say it hasn't any disabled persons. Since I cant' uses religion in debates I relay on Shakespeare again Richard III (simply start reading the introduction it is there). How long Disabled persons are shunned from society and how much similarities with the Jews they have...

But back to health care most laws passed in my country about healthcare ( yes we have it and it is as expensive as the US military) for Disabled Persons are made of politics and government officials that never have been in the situation but only "Think they do good " but in fact they only do the same numtyness on a very modernized level as they did in Shakespear's time. Thy use to show the uneducated on the matter that they doing the right thing, while trying ignoring any disabled persons organisation in country that tries to step in and try to speak on the behalf of the disabled persons and make the laws better and more valid and not sportive for a minority of a minority. ( trying to divide them by laws is bad enough but in politics itis deadly for a democracy if politicians uses classicism in laws. No morals no ​​values, not even established standards and signed treaties are save then.)

Having no Healthcare for anybody helps to get rid only faster of the *prob*.. (sorry it was a try to display how some people ignore the word on purpose to express what they really think) ... of course i was trying to say... disabled persons and this would be on the long run. Ableism, social Darwinism and eugenics on politics are again on the rise and someone must be careful or we fall back in less civilized times. Nowadays with what to change for the better for the non disabled and then you need to watch out because if that happens nobody wants to have a disability and it is hard to lose one if you already got one.

( I here by offer my bad back and hip (reduced nerve strands) and my two hernia incidents that caused that to any non-disabled person. May somebody else walk like a Neanderthal man without pain. And my regards if you feel pain in seeing me in this topic in walking tall which is normally not my thing on the streets in RL *hope somebody got the irony here* )

 

 

Funny thing Silver, I read those 6 CPS questions, and in spite of having Cerebral Palsy, Epilepsy, and now age related Osteoarthritis, I do not qualify as disabled by that 6 question yardstick. I can manage, with very little difficulty those "activities of daily living" , or AODL, which are the basis of the 6 CPS questions. The one AODL difficulty I can say I might qualify with is holding the first "ear" of the bow you tie in a shoe lace with my disabled hand wilst completing the bow tie with my non-disabled hand (but I do manage it). Thus, by that set of CPS questions, I would remain unidentified. :P

[grannywils]

@Sukeban

 

Thank you for pointing out to me that Social Security and Medicare are completely different animals, a fact of which I am eminently aware. :yes: Although I did mention Social Security and Disability along with Medicare in my opening remarks regarding being a senior, you will probably have noted that the gist of my post was, indeed, about Medicare and the cost of healthcare in general, particularly for seniors.

 

Based on your excellent and masterfully written response post, however, I am of the opinion that I failed entirely to get my point across. I will make one more feeble attempt here.

 

I do not doubt your figures or your estimates of costs in any way whatsoever. However, what I have been attempting to point out is that I see no reason on (moderator's please pardon the following expression. It is not meant to be religious...:ohdear: ) God's Green Earth for the majority of the costs you describe to be what they are. I believe and have believed for sometime that we, i.e. the American people, are being gouged royally by the aforementioned insurance and medical communities. I further believe that the senior community is getting gouged the hardest. This may be partially due to the fact that many seniors, especially those living alone or with some impairment, may find it hard to understand some of the monumentally difficult paperwork that is provided to them. I do not for a minute believe that the redtape and confusing paperwork is unintentional. I am not a conspiricy theorist, just a pragmatist. This to me is fairly obvious.

 

As I mentioned towards the end of my earlier post, what I am trying to get at is a means by which all Americans of any age, health condition, financial status, etc. is able to obtain quality affordable health care and/or medications from practioners and pharmacoligists who do not feel the need to (bleep) :verymad::ohmy: them at the same time....

[Lisnpuppy]

All right...since I am moderating this one now I don't get to play anymore. I think the point has been made here. I do not really think Suke is wanting to shove all the old folks in the closet and forget to give them food. I think she is trying to look at an extremely complicated issue from at neutral standpoint...like the government doesn't care about my Dad and his health issues..they look at where the money goes and where the drain is.

 

However I think both sides on this have made their points and I really see no reason to continue on in that vein. So if one of you would like to discuss this matter in a different light I most strongly urge you to do so before this begins to spiral out of control.

 

So...do you think the Supreme Court will reject this one? Why or why not? What would be the fallout? On what basis could they make a decision one way or another.

 

Talk among yourselves...:thumbsup:

[sukeban]

@grannywils

 

My apologies for being pedantic. I re-read that sentence and face-palmed.

 

I share your sentiments and agree that what individuals (from children to seniors) are charged for healthcare is in no real way connected to the actual costs of the procedure/medication/equipment/etc. I completely agree with you that insurance companies do this because they can. Because, unlike most other (all others, if you believe the Solicitor General) industries--people need healthcare, and not purchasing it (or receiving it even if it hasn't been purchased, i.e. the emergency room) isn't an option. No dispute whatsoever here.

 

I would just add that this isn't entirely a clever price-gouge by the insurance companies, though it is a large consideration. Our entire model more or less encourages it (of course that model has been supported by insurance companies for precisely this purpose). The entire fee-for-service model is completely bunk. All it does is encourage doctors to run more tests, proscribe more medicine, order more procedures, do more "stuff" so that they can get a larger payday when Medicare or the insurer decides to reimburse them. This is exacerbated in the case of Medicare because, following the same line of argumentation that conservatives use to cudgel public employee unions, management (Medicare, the government) has no real incentive to even try and control costs because they don't have a bottom-line to worry about. If worst comes to worst (lots of useless procedures ordered by cash-hungry doctors/clinics), they can simply issue more debt to pay for it.

 

Then, of course, there are medical malpractice lawsuits to worry about, many of which (I would guess, given the volume of shady class action suits advertised on television) are utterly without merit, brought by ambulance-chasing crook trial lawyers more interested in their cut of the settlement than in seeing actual justice done. Trial lawyers are huge Democratic donors, by the way, which might explain their... reticence to reign in this type of behavior.

 

Then there is what I spent the last post talking about (or perhaps howling at the moon...). I won't re-litigate that here, but, as we hopefully can agree, it represents a ton of our national healthcare spending.

 

So what to do to improve this situation, to drive costs down or hold them steady?

 

1. Abolish fee-for-service. Pay doctors for actually improving the health of their patients, not merely for doing "stuff." This would obviously need some ironing-out, but if doctors knew that they would get paid more for achieving positive health outcomes using fewer resources, it would be a powerful incentive toward reducing the amount of unnecessary medical care, driving down demand.

 

2. Compile a list of "best-practices" (most efficient) for remedying most maladies. This ties into the above. Certain treatments should be proscribed first, unless it is medically unwise given a unique situation. More expensive treatments should always be saved for last. This improves the odds that a patient will be healed using fewer dollars, rather than diving in immediately to the most expensive option.

 

3. Severely curtail medical malpractice suits. Only the most egregious errors or intentional harm (does that even happen?) may proceed to trail.

 

4. Establish some sort of an age ceiling (85?) when expensive life-saving procedures/treatments will no longer be covered by the government. Private insurance plans can fill this niche, if one so desires.

 

5. Establish medical insurance oversight boards like there are for auto insurance. Companies cannot raise premiums until they have justified to the board why the increase is necessary.

 

6. Focus on preventative care for the young and middle-aged (and seniors, too). Give a substantial tax deduction for meeting certain Body Mass Index thresholds and/or for being a non-smoker/drinker. That way, people are not "punished" for making "bad" lifestyle choices (morbidly obese smoker), but they are genuinely encouraged to keep themselves healthy in order to realize a financial gain.

Anyway, that's all I can think of for now.

 

EDIT:

 

My apologies, Linspuppy, I started on this post before I saw yours above me.

Edited March 31, 2012 by sukeban

[grannywils]

In response to LP, I apologize if it sounded as though I was overstating my point. It was not my intention to do so. I truly felt as though I perhaps had been unclear in my one initial post and was attempting to clarify in my second. I will make every effort to be more succinct in the future and not go overboard.

 

As far as what I think the Supremes will do, you've really got me there. At one time I would have been able to provide you with a more positve response. However, I feel the the Court has become more politicized these days, and I am no longer as convinced of its total detachment as I once was. That being said, I feel that the wind is blowing us somewhat in the direction of business and corporate America, and the answer will lie wherever it can do them the most good.

 

In response to Sukeban, I do believe that many of your points have merit, but overall they make me feel as though we, as humans, are all part of some vast machine-like matrix, and that we need to fit into certain niches in order to qualify for life as we used to know it.

 

Don't get me wrong, unfortunately I believe that I understand from whence you are coming. I just do not believe that it is where we belong. I still think that your proposals, while sensible, given the conditions in which we find ourselves, are addressing the symptoms rather than the disease.

 

 

[ginnyfizz]

In response to Sukeban, I do believe that many of your points have merit, but overall they make me feel as though we, as humans, are all part of some vast machine-like matrix, and that we need to fit into certain niches in order to qualify for life as we used to know it.

 

Granny, you are a star.

 

Using the discredited BMI as a yardstick to decide tax breaks, sukeban? I know many a sportsperson who'd fail the BMI yardstick just because they are big and strapping, and there is many a slim supermodel who is manifestly unhealthy. I've seen many an 18 stone international rugby player run the length of the pitch for example, I've never seen a supermodel who could do it.

 

Some people DO struggle with their weight due to disease - I had PCOS which can cause weight issues, and I won the battle with the weight gain, but it doesn't work for everyone.

 

You see where I am leading? This idea of carrot and stick for fulfilling arbitrary and flawed criteria will never fly, and certainly is not one for the US to base healthcare policy on. Again if our experience is anything to go by, such a policy would lead to MORE lawsuits, not less. Some of our health trusts have tried going down the route of restricting care on such grounds as described and been sued.

 

"The quality of mercy is not strained

It droppeth like the gentle rain from heaven..."

 

A good motto, methinks. Nothing like a bit of Billy Shakespeare.

[Lisnpuppy]

Actually what she proposes though sensible in some ways, is exactly like the HMO system that American's struggled under for years. It seems to end up that the insurance carriers are managing the care and not the physicians. Also when I had a medicaid insurance in the past, it was operated like an HMO and did not run any better. In fact Medicaid and Medicare until after I had my card, did not pay for a woman to have preventative pap smears for cancer prevention until AFTER a woman was diagnosed with cancer. Bit like throwing the baby out with the bathwater.

 

I think a first step would be to train physicians differently. Now they are indeed very symptom oriented. They pay an ungodly sum in their malpractice insurance,, as Suke said due largely to the climate of a litigious society in which we live. Doctor's need to be held responsible but there are so many nonsensical lawsuits. Yes, Suke there is intentional harm at time. Intentional at least in the form of the very high amount of drug and alcohol use by physicians that has a history of being hidden. I worked in a Drug and Alcohol treatment for several years and directly with a physician system set up with the State Board of Medicine. It is a bad problem but as bringing this to lite usually involved the physician losing his medical license the family and staff will often facilitate hiding this as their livelihood is also dependent on the physician.

 

Pharmaceutical companies need to be brought to heel. I understand the cost of bringing a drug to market but judging from the amount of ads for depression, diabetes and erectile dysfunction on television at any given time I know they must be making a bit of cash. If we did not have a medical flexspend with my husband's work I would not be able to afford my medications. As it is I pay near $500 out-of-pocket and I have pretty good drug coverage. I would be responsible for one drug alone of more than $200 for a 30/day supply. People on a fixed income like we are...well the hard choices get made as to what you can live without.

 

Lawsuits do need to be better managed but it will take some doing. I worked for about 10 years for the medical in an auto insurance company and getting the 1st and 3rd party lawsuits in my state of West Virginia pulled back was insane. The malpractice then makes doctors treat as much for the patient as to cover-their-arse against lawsuits. We could be sued for things such as not responding to a letter from an attorney in a 10 day time frame. Its one thing where a file has been grossly mishandled but there was such advantage taken for this. Also when government is made up of mostly trial attorneys it makes changing difficult as this is their bread and butter.

 

As for making decisions about treatment based on age or the fact that end of life is inevitable....well even when a person is only being made comfortable to die it is a huge sum of money for their care and comfort. As to the other proposals...it might make sense on an accounting sheet but it will never happen. As you have seen from the very emotional responses it is too sensitive an issue and frankly, I don't think anyone deserves to be restricted from access to healthcare of ANY KIND because they fit in a certain category. Maybe it is irrational but people deserve hope to the end if that is what they choose. I would not make those same choices but as long as someone can still ask for help they deserve to get it.

[HeyYou]

Any sort of age-based rationing will never fly, for a variety of reasons. Sadly, I think the primary reason is, live people generate income. Dead ones do not. At this point in time, doctors/health care providers will go to extreme measures to keep someone alive, long past the point it makes any sense to.

[sukeban]

@ginnyfizz

 

This is less directed toward you, and more toward anybody listening to this debate. The BMI back-and-forth just brought it to the surface.

 

Okay. So where are your solutions? I am hearing why we cannot or should not be doing things from varying perspectives, but the actual alternative suggestions seem to be quite thin on the ground. I refer--yet again--to the Medicare graphics, to the fact that even our present outlays for Medicare/healthcare in general are unsustainable. Everybody seems to be ignoring these. These expenditures are driving our economy, our budget, and our government into the ground. Everybody seems to be taking the (out of context) Keynes quote that, "In the long run, we are all dead" to heart, that it somehow papers over the fact that as this present generation (my grandpa's) is passing away, they are saddling their children and their children's children with an enormous and irresponsible debt for services that they (actually their children, the Boomers) refused to pay for. Even if taxes were raised today to cover this, you have seen the trajectory that healthcare spending is on, how it shoots into the absolute wild blue in only a few short decades. Systemic changes must be made.

 

This is the premise that we should all be operating upon. That change must be made, not if it should be made. And Boomers are the ones who should be most shamed by this. My grandpa's generation put into place the New Deal and the Great Society. And they accepted high taxes in order to actually pay for it all. However, when the Boomers came of age, they decided that--though they liked these programs--they could not longer be bothered by the triviality of actually paying for them, that they would rather take out debt and place that debt--and its interest, presently ~7% of our federal budget--squarely on the backs of their children. Bravo.

 

Now, I know that nobody explicitly voted for this program (well, maybe the mega-rich who don't use these programs and hate taxes did...), but this is the way that things have turned out. You didn't see Eisenhower out there promising a flat tax or dropping the top tax rate to 25%. No, that was for Reagan, W. Bush, and now Romney. Indeed, Boomers, as measured by the governing outcomes effected on their watch, seem to have bought wholeheartedly into the idea that they may have their cake and eat it too.

 

So anyway, if my ideas are so bad--please, let's hear some actual alternatives. Ultimately, you can't get blood from a stone, and insurance companies will never be compelled to provide healthcare at-cost to consumers. Sure, you can nationalize healthcare and provide care at-cost (what I'd prefer), but I don't see that happening anytime soon in the USA. Demand for healthcare must be reduced, otherwise doctors and insurance companies will continue to charge what the market will bear. And again, since a public agency has no real incentive to try and keep costs down (federal credit card), the market can and will bear anything until systemic changes are made to ensure that this is no longer the case.

 

It is true that I am utterly unsentimental about this issue, but my heart is in the right place. I want to improve our healthcare system and make it sustainable. This comes with the stone-cold provident truth that not everybody can get what they want. Resources are not unlimited. Decisions must be made. IMO, healthcare is rationally dispensed when it provides the greatest amount of good for the lowest possible cost, i.e. in a utilitarian fashion. This goes over like a lead balloon in the post-WW2 United States because people have lost any sense of being part of a collective whole, a society. The "Greatest Generation" had this quality--for a time. Subsequent generations have lost it because (IMO) they have never experienced the same degree of collective hardship (Great Depression) or effort (WW2). Individuals certainly have continued to face private horrors and outrageous twists of fate, but I am speaking of events on a societal scale--something able to motivate voters, to shape public opinion, public emotion, public morality.

 

Ugh. I am trying my best to hold my tongue, trying to suppress my antipathy for the freakish dysfunction of this country, a dysfunction that has been, more or less, an advent of the Boomer generation--and their absolute failure to compromise or be rational, of their unfathomable narcissism. This goes mainly for the political class, but somehow these people do seem to keep getting elected....

 

So anyway, back to healthcare. It is true that in the long run we are all dead, but it is also patently irresponsible to act that way when there are other generations, other futures, to think of.

 

@BMI

 

Sure, maybe that's a flawed metric. Again, your suggestion? I don't want to pay for some dude's quadruple-bypass surgery after he spends his entire life pounding Colt 45 malt liquor and eating Velveeta cheese. Neither do I want to pay for a lung-transplant for the Malborro Man. At a certain point, "you make your own bed" in terms of terrible life decisions. Individual responsibility would insist that sometimes we should be made to lie in them. Perhaps sell "smoker's insurance" or "alcoholic shut-in insurance" or whatever. Sure, sometimes being overweight is indeed a disease--if a doctor diagnoses you with it, then there should be no harm. But people smoke entirely by choice. Ditto for drinking. Ditto, by and large, for being overweight and/or never exercising. This is especially a problem in the United States. How is it irrational to try and curb this sort of expensive, self- and societally destructive behavior? Especially using tax breaks where an individual is not actively being "punished" for making a bad decision, only that an individual may be "rewarded" for making good ones. If it is true for a child (or a pet), it should still be true for an adult--never reward bad behavior.

Edited March 31, 2012 by sukeban