News that Vermont's Senate recently passed a single-payer health care system must have gladdened many progressive hearts, but truth be told, future health care costs would bankrupt America even if single-payer systems spread nationwide.
That's because the problem's not in the accounts receivable department; it's the actual cost of health care, now growing at roughly seven percent a year. That's about twice as fast as the economy grows in an average year.
And since the future of Medicare is one of the things forced onto the table by Republicans as part of a deal to raise the debt ceiling, minimizing that rate of growth could mean the difference for many aging Americans between some health care, and, under the Ryan Plan, de facto health care rationing according to the ability to pay.
Meanwhile, saying you've solved America's health care crisis by changing how you pay for it is like saying you've stopped the spread of nuclear weapons by outlawing the nicknames of certain missiles. And because the country is getting older and sicker, focusing on how to pay, instead of what you pay, does almost nothing to bend the cost curve.
The Alzheimer's Association, for instance, says the cost of treating that disease will grow from $189 billion in 2015, to over $1 trillion in 2050. That's twice what we spend for Medicare today. And the National Cancer Institute expects annual cancer treatment costs will grow 27 percent by 2020, to $158 billion.
Can we do anything about this? Maybe, if we come to grips with the fact that there are worse things in life than death, that modern medicine offers many of them, and that with today's medical technology, a worst-case scenario isn't dying -- it's years of falling apart, slowly, ending with a few years of progressively aggressive treatment that basically keeps you, well, not dead.
This nightmare has been given to us by what Daniel Callahan and Sherwin B. Nuland, in a May 9th article in The New Republic titled "The Quagmire", call The War on Death. The article isn't available free online.
What we've bought into, say the authors, is the idea that we're all somehow going to live a long and healthy life, followed by a brief decline and a quick, easy death -- hopefully, while we're sleeping. A pretty picture; and pretty unrealistic.
"What we need is a different philosophy about death and dying," says Callahan, who's president emeritus of The Hastings Center.
The good news in that grim analysis is that it finesses the toughest political problem about medical care in America -- the screaming on the Right about so-called socialized medicine and death panels.
This is because what we're talking about here is mostly a matter of personal choice, and professional guidelines, not government programs. No faceless government bureaucrats play any part in this -- although personally, I've never seen any difference between faceless government bureaucrats making health care decisions, and faceless private health insurance bureaucrats making the same decisions.
This doesn't mean making choices like that is easy. It's not, not by a long chalk. Most people don't want to talk about dying. And that goes double for families with elderly parents, who will otherwise wind up managing their parent's care in those last, machine-filled days in the ICU.
But if we can bring ourselves, as individuals, to move past the fantasy of a good, long life and a good, short death as some sort of real probability; come to grips with the fact that, as medicine is practiced now, it's likely to put us on a road to the reverse; and organize our personal health care around avoiding that worst-case scenario; we can not only avoid that horror in the ICU -- we can maximize the likelihood that we, as a people, can enjoy decent healthcare for all, however we pay for it.
There are some other things we can do as well. For one, as Callahan and Nuland say, we can do something about the very high costs of medical school. As they point out, those costs force young doctors into the big-money medical specialties that let them repay their debts, but starve America for the primary care physicians we need to manage our health.
Another: we can stop buying the latest drug as if it was a flashy new toy, and rely on tried and true medicines that do pretty much the same job for fractions of what the new drugs cost. This is a different version of what Callahan means when he talks about needing a different philosophy about death and dying; these new drugs are inevitably sold as great advances in medicine, offering almost unlimited health, while never mentioning the cost.
A senior FDA scientist, speaking on condition of anonymity because he isn't authorized to speak to the press, told me that not only are the potential side-effects of most new drugs often poorly understood; but that they produce only very marginal improvements in results in return for vastly higher costs.
Securities research for pharmaceutical companies, for instance, routinely touts the financial value of such drugs not only because they produce higher profits today, but -- because they often have to be taken more or less permanently -- produce reliable, long-term revenue streams. This is great for pharmaceutical companies; but for Americans paying taxes and insurance premiums, not so much.
A third thing we can do: think about what we're giving our elderly relatives when we start fighting to keep them alive -- an all-too-common scenario-- and show some courage and compassion.
Let me tell you a little story. My best and oldest friend -- we were like brothers for 50 years -- died about three years ago from cancer-related complications. His wife was his health care proxy, and I was his back-up proxy. He had no hope of any recovery, his condition wasn't reversible, and he made us promise that whatever happened, he wouldn't end up on a respirator.
He did though, for reasons that don't matter now. It's enough to say he still didn't want to be on it, knew he was dying that day, and wanted to go. All his wife had to do was give the order to disconnect him; the medical staff was standing by.
But she couldn't pull the trigger. She's in no way a bad person; it just wasn't in her. I had to do it, and was proud to give my friend what he wanted. After all, he would have done it for me.
Of course, if I hadn't been there, the hospital would have had to do everything in their power to keep him from dying as long as possible, running up millions of dollars in bills that, one way or another, would have paid for by you and me. For no result.
I'm sure there are other things we can do to control costs instead of just deal with the payments piece. These are just three of them. But it seems to me that if we can screw up our courage, face the facts and choose wisely, we can have a batter life and a better death, and the American people can have better health care in the bargain.
That seems to me to be a goal worth pursuing.
Visit me at www.Reinbachsobserver.com
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This is not as simple as it sounds. There's a boatload of profiteering in medicine today. We need to dig deeper. Also, I'm older now and finding out that many docs won't accept medicare. In my opinion, it is all about greed, greed, greed.
The pay problem is that insurance companies are taking money but denying benefits. Single payer is about getting the most benefit out of money towards insurance.
Colleen Ahern
http://www.blockvision.com
Talk about pharmaceutical companies multiplying their income streams!
medical marijuana on the other hand has few to no side effects
"Health care costs too much money" right now for two reasons:
(1) "Costs too much money" for you, means "makes a lot of money" for me.
(2) Those who can pay get fleeced for those who can't.
And what is the obstacle to change? Well, in my bullet-point #1, consider who "me" is. It's not just the health-care provider companies; it's also politicians. Don't call them "campaign contributions" ... call them what they are: bribes. When you do that, you can turn to the twenty-fifth word of the fourth section of the second article of our Constitution and there you'll see the same word: "bribery," etched alongside "treason."
I think there's a lesson in that.
We either "get what we want," or we "get what they get paid for." And our founding document plainly says, Supreme Court notwithstanding, that the latter is illegal.
There's a good business argument in favor of universal care, too: On the one hand, a healthy workforce is a productive, efficient, and competitive workforce, so it's in the interests of business to promote said healthy workforce. On the other hand, our overseas competitors don't have the overhead for healthcare insurance American companies do, because said universal healthcare-the much-maligned "socialized medicine"--costs them less in taxes than ours does in employer premiums, so that they beat the pants off us in contract bids, get the business, and maximize market share.
Yet the US Chamber of Commerce opposes anything like universal health care, allegedly out of concern for increased government intervention in the marketplace. The real concern, of course, is decreased profits for the healthcare industry in all its iterations. And our government, gears oiled by the "campaign contributions" you so correctly identify as bribes, goes along.
I know there's a logical disconnect in there somewhere....
Ranting, Raving, Lunacy.
I feel better now. ( :
Maybe then we could accept that if it can't be cured by old stand-bys or nutrition that our time is over?
I agree with the author that our attitude toward life and death are at the heart of the problem.
We expect we should live into our 80's , Perhaps that should be revised ?
If we make healthier choices we would all save a lot of money.
http://www.huffingtonpost.com/2011/05/23/seth-petreikis-baby-with-_n_865490.html
His death is blamed on not having publicly funded transplants, regardless of the cost (the surgery alone, an experimental procedure, would've been $500,000; and then appx $2500 in anti-rejection drugs thereafter).
Reading the comments, people are utterly horrified that every single measure possible was not take to save this child's life... without any context at all the public cost.
No, you cannot put a price tag on a life. However, the concept that the infinite value of human life means you should be able to take infinite money from other people to pay for a human life is not only unrealistic but also inhumane, because in doing so you deprive others of ability to pay for their needs and the needs of their loved ones.
Unfortunately our healthcare system sets no realistic limits on their instinctual efforts to fight for their child
In many other cases we start down a slippery slope without meaning to go there. I.e. someone has a stroke and gets a" temporary" feeding tube , til they regain their ability to swallow. But then that never happens ,instead they worsen but the feeding tube prevents their death
So I've told my doctor not to check for prostate, nor bowel cancer, no lung cancer. I have a rare blood condition and I have that treated the old fashioned way.
Americans live in total fear of their bodies and allow doctors to hunt and spend money we cannot afford all so they get a great living. Fine but I take the advice of a surgeon once asked about his secret of good health: Never EVER go to a Doctor.
I now avoid the doctor's office and think I should get paid to do so:)
Problem 7- COsts of medical goods and drugs.
Solution: By removing the "competitive" barriers with the institution of a non-competitive, not-for-profit system, these systems can group together to buy drugs and goods, dropping the price significantly. Just one of the reasons drugs cost so little in other parts of the world.
Problem 8- all the problems discussed in this article. We currently spend around 25% (some studies) on primarily ICU care in the last 2 weeks of life. Great for the specialists, bad for cost.
Problem 9- Too much specialist care in ICU's.
Solution: Every facility with more than 20 ICU beds should be using Intensivists. Significant drop in costs and better outcomes.
There are others of course
Solutions: get rid of "corporate" health care and re-structure the system into a truly community based not-for-profit system that can be held accountable for "health" in a given area. The Public Utility model can help with the transition since we did this before with energy (electricity in particular). Many of the same problems.
Problem 2- too few primary care practitioners and too many specialists in some areas.
Solution: Open up the doors for Nurse Practitioners to fully practice in all 50 states. More innovative primary care delivery models based on community needs, not physician driven 9 to 5 operations.
Problem 3- Administrations who know very little about healthcare.
Solution: Let nursing run our healthcare facilities..they know healthcare and are fully committed to patient care.
Problem 4- 1,000 different insurance plans. None of us can truly predict the healthcare needs we will have down the road. We need a single payer system to control pricing and distribute the resources equitable.
Problem 5- Lack of individual accountability. We all know to eat a balanced diet, get regular exercise, avoid fatty foods, not smoke, control our weight, etc.
Solution: unknown. How many different ways can we say this?
On the other hand, medicine has portrayed this image of always having the right drug and procedure for everything just about.
If we go to physicians for care, and refuse to care for ourselves, what can we expect?