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  #1  
Old 02-26-2009, 01:12 PM
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Default Brushes with Greatness

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  #2  
Old 02-26-2009, 02:35 PM
Joel_Cairo Joel_Cairo is offline
 
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Default Re: Brushes with Greatness


http://bloggingheads.tv/diavlogs/179...1:39&out=01:52
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  #3  
Old 02-26-2009, 03:02 PM
bjkeefe bjkeefe is offline
 
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Default "And What Do You Think Of, Bob?"

Fine, but why did your voice go up three octaves?
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  #4  
Old 02-26-2009, 03:10 PM
claymisher claymisher is offline
 
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Default Re: "And What Do You Think Of, Bob?"

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'cos that's what soul singers do.
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  #5  
Old 02-26-2009, 03:34 PM
bjkeefe bjkeefe is offline
 
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'cos that's what soul singers do.
Awesome answer.
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  #6  
Old 02-26-2009, 03:06 PM
bjkeefe bjkeefe is offline
 
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Default Another Question

Just how old is Mickey, anyway?
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  #7  
Old 02-26-2009, 04:17 PM
Happy Hominid Happy Hominid is offline
 
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Default Re: Another Question

Hey! I GOT the reference!
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  #8  
Old 02-26-2009, 04:21 PM
bjkeefe bjkeefe is offline
 
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Hey! I GOT the reference!
Yeah, but you're smart.
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  #9  
Old 02-26-2009, 05:20 PM
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Default Re: Another Question

No... I remember it because of my age. But thanks.
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  #10  
Old 02-26-2009, 05:21 PM
Happy Hominid Happy Hominid is offline
 
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Default Goldie Hawn

Not "Smother's Brothers", Bob. "Rowan and Martin's Laugh-In". Unless she made some one-time appearance on SB that I don't recall.

Yes, Brendan, I'm showing it again...
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  #11  
Old 02-26-2009, 03:26 PM
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Default The Joys of Rationed Healthcare

So, Bob admits - rightly - that excellent, expensive, high-tech healthcare is going to have to either be rationed or otherwise severely limited. Why oh why would anyone or any company make some high-tech super-duper cure-all machine when it knows from the outset that it will never recoup its costs? This is the flaw of universal coverage. I applaud Bob's admission of that fact, but it doesn't precisely fill me with confidence in the forthcoming control over my health by HHS.
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  #12  
Old 02-26-2009, 03:33 PM
AemJeff AemJeff is offline
 
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Default Re: The Joys of Rationed Healthcare

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...Why oh why would anyone or any company make some high-tech super-duper cure-all machine when it knows from the outset that it will never recoup its costs? This is the flaw of universal coverage. ...
This is an assertion begging for support. It's refuted by the facts in plenty of countries with universal health care. Health care is always rationed somehow, btw - regardless of the economic model used to support its funding. Maybe rationing based on accidents of circumstance isn't the best model.
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  #13  
Old 02-26-2009, 03:38 PM
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Default Re: The Joys of Rationed Healthcare

Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse. Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.
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  #14  
Old 02-26-2009, 04:03 PM
claymisher claymisher is offline
 
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Default Re: The Joys of Rationed Healthcare

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Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse. Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.
That's not the way it works. Every country except Canada still has private medicine. You can spend as much as you want. No one will stop you.

There's also still a free market for medical technology. If you can deliver a cheaper MRI machine, or a machine better than an MRI, hospitals will buy it. Same with gloves, computers, gurneys, etc.

There are hundreds of reason why the analytic tools you learn in econ 101 don't apply to health care. That's more of a problem for econ 101 than anything else.
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  #15  
Old 02-26-2009, 04:07 PM
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Default Re: The Joys of Rationed Healthcare

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Every country except Canada still has private medicine. You can spend as much as you want. No one will stop you.
Well, in that case, why worry? We probably won't end up like Canada.
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  #16  
Old 02-26-2009, 04:14 PM
AemJeff AemJeff is offline
 
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Default Re: The Joys of Rationed Healthcare

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Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse.
No, of course not. the least unfair system would be triage, prioritizing by need and then applying applying a cost/benefit analysis. (e.g. If two people need heart surgery, pick the one not in late stage cancer first. [Obviously this is a cartoon just to illustrate the logic; extreme circumstances like this are already decided pretty rationally.]) There would be ugly consequences of such a system, but there are ugly consequences of the present system.

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Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.
That's ridiculous on its face, unless somehow you think that curing a poorer person doesn't constitute a benefit to that person. I'm sure you don't believe that.
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  #17  
Old 02-26-2009, 04:20 PM
bjkeefe bjkeefe is offline
 
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Default Re: The Joys of Rationed Healthcare

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Originally Posted by Rich View Post
Isn't the least unfair method of rationing the use of the market? In other words, if we rely on government to decide who benefits - i.e. rationing - there's nothing but the potential for abuse. Preventing people who can afford high-end healthcare from getting it in order to be fair to those who cannot doesn't actually help anyone.
Not to pile on or anything, but it seems to me that the goal of health care reform is to ensure that everyone has access to a minimum level of care, and to the degree that costs hamper pursuit of this goal, you adjust by pushing down what you mean by "minimum level." For example, you might want everyone to be able to get one free checkup per year, and maybe you have to scale it back to one free one every two years for everyone except kids and new mothers. (NB: there is nothing meaningful about this example -- it's just made up to illustrate.)

As far as I know, no serious wonk wants to set up a system where we'd have no doctors in private practice; i.e., if you want to pay for more than the national plan offers you, you'll be able to, up to your own ability to pay. I suspect, also, that there will not necessarily be no private insurers under any plan that has a chance of passing, so you'll continue to be able to opt to pay for your own additional coverage this way, too.
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  #18  
Old 02-26-2009, 11:06 PM
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Default Re: The Joys of Rationed Healthcare

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For example, you might want everyone to be able to get one free checkup per year, and maybe you have to scale it back to one free one every two years for everyone except kids and new mothers.
I suggest checkups are a rounding error. The cost of checkups is trivial compared to the costs of diagnostic radiology, chronic care, and end of life care.
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  #19  
Old 02-27-2009, 08:22 AM
bjkeefe bjkeefe is offline
 
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Default Re: The Joys of Rationed Healthcare

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I suggest checkups are a rounding error. The cost of checkups is trivial compared to the costs of diagnostic radiology, chronic care, and end of life care.
Possibly. But as I said, I offered this example only to illustrate what I meant by the concept of a "minimum level of care for all" as the thing that would be adjusted to contain costs, as opposed to Rich's fears of "rationing." It was not something which I made any real-world, dollars-and-cents claims about.
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  #20  
Old 02-26-2009, 10:59 PM
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Default Re: The Joys of Rationed Healthcare

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It's refuted by the facts in plenty of countries with universal health care.
What's an example?
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  #21  
Old 02-26-2009, 11:19 PM
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Default Re: The Joys of Rationed Healthcare

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What's an example?
France.
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  #22  
Old 02-26-2009, 11:39 PM
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Default Re: The Joys of Rationed Healthcare

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I've heard great things about the French system, but I think Rich's point pertained to the expensive innovation of medical technology. I would bet that the lion's share of such innovation comes from the States. How is that innovation funded in the States? That leads us to another issue . . . . All I'll say on that point is that I wish Obama spent a zillion dollars on research grants to universities instead of trying to keep a bunch of dumb-ass would-be dropouts in high school.
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  #23  
Old 02-26-2009, 11:55 PM
AemJeff AemJeff is offline
 
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Default Re: The Joys of Rationed Healthcare

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I've heard great things about the French system, but I think Rich's point pertained to the expensive innovation of medical technology. I would bet that the lion's share of such innovation comes from the States. How is that innovation funded in the States? That leads us to another issue . . . . All I'll say on that point is that I wish Obama spent a zillion dollars on research grants to universities instead of trying to keep a bunch of dumb-ass would-be dropouts in high school.
Rich was positing a hypothetical: Would there be sufficient interest in investment toward developing high-tech medical equipment in a country that subscribed to a single-payer model? The underlying assumption there is that a single payer system can't support the level of profit required to motivate that sort of innovation. My point is that are examples of healthy systems, France particularly, but to my understanding even the much more maligned Canadian and English systems (among others), that argue clearly against that assumption.
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  #24  
Old 02-26-2009, 03:54 PM
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Default Re: The Joys of Rationed Healthcare

Every western European country has better health care than the United States. People live longer and they generally enjoy better health throughout their lives in Europe---while paying considerably less for their doctors and medicines. The World Health Organisation rates the health care systems of every country in Western Europe as superior to that of the United States. "Socialized" medicine clearly has its advantages...

"Superduper" treatments and machines are wonderful at prolonging life when life is hardly worth living. Perhaps Americans should think less about having a well-engineered death and more about living well.
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Old 02-26-2009, 04:05 PM
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Default Re: The Joys of Rationed Healthcare

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Perhaps Americans should think less about having a well-engineered death and more about living well.
I'm certain that Americans are welcome to start thinking just that way. Ought they be forced to think that way by their government? I'm not sure that's a future that is all that bright, really.
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  #26  
Old 02-26-2009, 04:18 PM
AemJeff AemJeff is offline
 
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Default Re: The Joys of Rationed Healthcare

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I'm certain that Americans are welcome to start thinking just that way. Ought they be forced to think that way by their government? I'm not sure that's a future that is all that bright, really.
Rich, you're making it up as you go along. Nobody's being forced think in any specific way. Democracies decide on big policy ideas and then they implement them. Sometimes it's the right thing, sometimes it's not. there's nothing special, in that sense, about healthcare.
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  #27  
Old 02-26-2009, 11:41 PM
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Default Re: The Joys of Rationed Healthcare

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I'm certain that Americans are welcome to start thinking just that way. Ought they be forced to think that way by their government? I'm not sure that's a future that is all that bright, really.
Healthy people must be forced to help subsidize the medical costs of sickly people.
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  #28  
Old 02-26-2009, 04:57 PM
bjkeefe bjkeefe is offline
 
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"Superduper" treatments and machines are wonderful at prolonging life when life is hardly worth living. Perhaps Americans should think less about having a well-engineered death and more about living well.
I agree with this completely. This is going to be a big battle, though. Part of the way to make a national plan affordable, by my guess anyway, will be to set fairly stringent limits on heroic measures aimed at keeping a near-carcass just barely ticking over. One has only to think about the Terri Schiavo fiasco to realize this. I did draw some comfort when I realized the majority view was "just let her go," but it was also clear that there were plenty of people eager to demagogue this (and probably some sincerely believing she should be kept hooked up to the machines, admittedly) and it was painfully clear that the MSM was happy to report this for way too long as a "balanced" story.
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  #29  
Old 02-26-2009, 05:31 PM
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Default Re: The Joys of Rationed Healthcare

There have been similar cases in Europe too. In Italy for example, quite recently, there was a woman who had been in a coma for many years and was allowed to die after long legal batttles, to the great indignation of the Pope and many fellow Catholics. Such cases reveal a bizarre alliance between religion and medical science, which are both committed, though for different reasons, to preserving life at any cost.

I once read, but I have never been able to verify this, that approximately 90% of what most people (i.e. those who live a normal life span) spend on medical costs over their entire lives is spent in the last six months of their lives. In other words, dying is an expensive business.
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  #30  
Old 02-26-2009, 06:17 PM
bjkeefe bjkeefe is offline
 
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There have been similar cases in Europe too. In Italy for example, quite recently, there was a woman who had been in a coma for many years and was allowed to die after long legal batttles, to the great indignation of the Pope and many fellow Catholics. Such cases reveal a bizarre alliance between religion and medical science, which are both committed, though for different reasons, to preserving life at any cost.
Yeah. We should probably think about updating medical ethics. (I'm sure many people are engaged in that effort, actually.)

Quote:
I once read, but I have never been able to verify this, that approximately 90% of what most people (i.e. those who live a normal life span) spend on medical costs over their entire lives is spent in the last six months of their lives. In other words, dying is an expensive business.
That sounds very familiar, at least as a ballpark figure. I wonder how true it is; e.g., does it include the entire population, so that all those young people who get killed are counted in figuring the average/median? Even if not, and the count is just restricted to people who die a "natural" death, it's still awfully problematic, if accurate.
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Old 02-26-2009, 07:55 PM
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Default Re: The Joys of Rationed Healthcare

Agreeing that none of us who have posted thus far have hard data to quote, a few impressions here -

The cost/age curve for healthcare is likely "bathtub" in shape since small children are also notable consumers of health care for the first few years. I don't know if you have, or have had, or have been around very young children but they get sick a lot, and the smaller they are the less margin you have or are willing to accept for their health risks, in general. The immune system just isn't up to snuff at birth, and most of us aren't programmed to accept suffering by infants well.

The end of life spike in health care costs in part reflects what is likely to be under-utilization of preventative care and health monitoring during most of life. Lots of folks don't see a doctor for years on end until we break something obvious, or get an infection that we finally give in and admit we can't shake on our own. As the medicos point out, there are various things that can be handled better, and persumably or at least possibly cheaper, if caught earlier by more, rather than less, utilization of health care resources on a more regular basis. Cheaper (and certainly better) that is for those individuals who have problems that would be caught earlier. Somebody somewhere probably has an estimate, or sets of conflicting estimates, as to what the overall dollar cost of regularly checking everyone more frequently and thoroughly would be and how it would change the overall cost picture.

It would be interesting to see the cost/age curves for other industrialized societies that have more universal health care, but I would suspect there is and will always be an increase toward the end of life. Sort of goes with the territory, that is where things start to break down. For a lot of people this involves medication for various things, such as helping regulate blood pressure, which allows them to lead fairly normal lives. Its not just people lying in a hospital bed hooked up to machines that will keep them going for a couple of miserable and desperate last weeks.

Regarding the latter, as in the Shaivo case, and your point about ethics, I think ethics and morality evolve in ways noted in one of the Free Will diavlogs. To spare us all my frequent divergent ramblings I'll just suggest that as such they probably always lag the changing conditions that lead to such evolution.
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  #32  
Old 02-26-2009, 08:17 PM
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[...]
Good points, especially about the likely high early-in-life costs.

You're probably also right about the likelihood of things being more expensive due to people postponing getting attention (or regular checkups, for that matter). However, I do wonder about this one. When I have worked at places where there was good health coverage, I have always noticed people who go to the doctor for just about everything. I'm talking sniffles and a cough, a twinge in a joint, like that. And why not, from the self-interested perspective?

So while I agree that there are lots of cases where putting things off until they get worse means higher costs, I also think there are lots of cases where once the personal costs are low enough, there can be over-consumption of what is ultimately a shared resource. Worse, when this changes even in the slightest, there tends to be howling, which you know will be a fear card the reactionaries will play in the upcoming war. I remember when one company I worked at tightened up a bit, to try to control costs, and the outcry at the change of five or ten bucks co-pay for a doctor's visit was not to be believed.

I can't believe I'm relating anecdotes in a health care policy discussion. I hate that. Ending now.

But good post by you.
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  #33  
Old 02-26-2009, 11:57 PM
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Default Re: The Joys of Rationed Healthcare

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The end of life spike in health care costs in part reflects what is likely to be under-utilization of preventative care and health monitoring during most of life.
This is not logical. To the extent that preventive health care extends life, especially into age brackets that don't pay Medicare taxes, it increases lifetime medical costs. The end-of-life spike costs the same, it just comes later. From a costs perspective, we should wish for people to never go to the doctor, then die from a massive stroke before they hit the floor, the month before they become Medicare eligible.
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Old 02-27-2009, 11:51 AM
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Default Re: The Joys of Rationed Healthcare

It is actually very logical in context.

Commenters often quote part of a post in replying in order to clarify just what they are replying to, since many posts ramble a bit or make varied assertions. Commenters also often extract a sentance and attack it out of context. This may reflect a lack of reading comprehension, an attempt to have an argument, or be a way to try to show they are smarter or cleverer than the original poster - and in the case of my posts folks should really set the bar rather higher than that for themselves. I always find this practice of context eliminating quoting rather annoying since it involves misrepresentation of the original poster's meaning and intent. I am going to pick on you for doing so. Just because.

A point of discussion in the two posts previous to mine in the thread raises the question of people incurring nine times the health care costs at the end of their lives that they incurred during the rest. As indicated by my discussion of health care costs represented as a cost/age curve, rather than just a dramatic possible factoid, I suggest considering the entire data set. If one spent more throughout life, the end of life spike would be less dramatic with respect to the whole. In some instances the costs represented by that spike would be less, in other instances perhaps not. Further, if you read and consider the paragraph immediately following your excerpted sentance, you will note that I explicitly opine that there will likely always be greater end of life costs, broadly defining that term, and that it is reasonable and natural that it be so.

If you reread and consider the rest of the paragraph from which you extracted the sentance you quote, I also question whether a greater use of preventative medicine and health monitoring throughout life on a population-wide basis reduces overall costs or not. None of us has yet referenced credible data to indicate either way.

Perhaps you have a bee in your bonnet about Medicare, but your injection of it is irrelevant to the problem of life cycle costs for medical care. The issue of who signs what check during which year of life does nothing to address the problem of overall costs, nor whether the health care systems in other countries that have better overall care at lower costs spend more throughout life and less during the "end spike".
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  #35  
Old 02-26-2009, 07:52 PM
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Default Re: The Joys of Rationed Healthcare

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Such cases reveal a bizarre alliance between religion and medical science, which are both committed, though for different reasons, to preserving life at any cost.
Yes, what could be worse than prolonging life at any cost? Living wills seem to cover this sort of problem already. The reason it becomes a serious issue in a state where healthcare is a state-sponsored right is because everyone is forced to pay for it. Why not just keep the system we have and avoid the problem? The Schaivo case is another fine example of the way our system seemed to actually function: the courts deciding a legal battle over the custody of an adult, in essence. Had everyone kept out of it it would have worked out just as it did. Why must we give the power to the government in the first place? Let's maintain the system we have.
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  #36  
Old 02-26-2009, 08:00 PM
AemJeff AemJeff is offline
 
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... Let's maintain the system we have.
You obviously have no chronic illnesses and are currently insured.
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Old 02-26-2009, 08:09 PM
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Why must we give the power to the government in the first place? Let's maintain the system we have.
A lot of us find this to be a false choice. I don't want a group I have as much contempt for as I do politicians getting into my healthcare decisions. I do however recognize that a system so inefficient that it costs us far more per capita than in other countries we compete with, to get rather poorer health care (averaged across our citizenry) is not one that begs to be left as is.
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  #38  
Old 02-26-2009, 08:21 PM
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Let's maintain the system we have.
I vote no, too. Too many people are uninsured or under-insured, too many people get wiped out by one-time medical events, too many people are trapped at jobs they hate because they have "a preexisting condition," and too many companies are getting crushed by rising costs.

I'm sure there are lots of other specific reasons, but the bottom line is that our system could be a lot better, and is completely broken from the perspective of tens of millions of people.
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  #39  
Old 02-26-2009, 11:50 PM
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Default Re: The Joys of Rationed Healthcare

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One has only to think about the Terri Schiavo fiasco . . . .
Terri Schiavo is an outlier, and for me an easy issue. 100% of us will die, the vast majority a lingering death. Terrifically difficult choices attend most of those deaths. Do we put Mom through a rough, tough surgery, or do we move her to hospice and hope they're generous with the morphine. Is Dad's life really going to be better with a hip replacement (hip replacements are a huge Medicare expense)? The oncologist starts with the chemo most likely to succeed, and when it fails he moves to the next one, and when it fails he moves to the next one, etc, etc, etc, all this done in the oncology ICU. These are not outlier examples, they are routine.
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Old 02-27-2009, 08:29 AM
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Originally Posted by Anyuser View Post
Terri Schiavo is an outlier, and for me an easy issue. 100% of us will die, the vast majority a lingering death. Terrifically difficult choices attend most of those deaths. Do we put Mom through a rough, tough surgery, or do we move her to hospice and hope they're generous with the morphine. Is Dad's life really going to be better with a hip replacement (hip replacements are a huge Medicare expense)? The oncologist starts with the chemo most likely to succeed, and when it fails he moves to the next one, and when it fails he moves to the next one, etc, etc, etc, all this done in the oncology ICU. These are not outlier examples, they are routine.
I think we agree philosophically about high costs at the end of life and how that's going to be a hard problem when trying to arrive at a deal. My use of Terri Schiavo was merely to illustrate how much passions are going to be inflamed once we start acknowledging that a bottomless well of treatment, for someone who has virtually no chance of getting better, is not going to be in the cards.
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