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Tuesday, January 5, 2010

Continuing on our elderly theme...

I feel like continuing to myth-bust today:

One of the more popular myths created by the American health care obfuscation machine (AHCOM) is the absolute nonsense that our elderly are responsible for escalating health costs.

Let me go on record right now as stating the idea is pure rubbish. And since others have addressed this topic much better than I could ever hope, I will simply refer you to some of their work. You can read it if you want at your own leisure.

What I do want to comment on is the following NYT article. For it makes quite clear why I (and many others of a similar mindset) get so frustrated at the way our collective is allowing its resources to be used and why I think you and I might simply be better off if we just chose how to spend the money ourselves.

"federal spending for health services and supplies increased 10.4 percent in 2008... By contrast, the report said, state and local government spending on health care increased just 3.4 percent in 2008...

While federal spending on health care surged, consumers and private employers retrenched. Spending for health care by private businesses grew just 1.2 percent in 2008, in part because of a drop in the proportion of employer-sponsored insurance paid by employers,” Mr. Hartman said. “Private business’s health spending remained relatively flat as a share of compensation at 7.9 percent.

Moreover, the report said, “private health insurance premiums and benefits grew in 2008 at their slowest rate since 1967, 3.1 percent and 3.9 percent, respectively.” The slowdown was tied to a drop in the number of people with private health insurance, to 195.4 million in 2008, from 196.4 million in 2007.

Spending increases varied among health care providers in 2008, rising 4.5 percent for hospital care, 4.6 percent for nursing homes, 4.7 percent for doctors’ services, 6.6 percent for outpatient clinics and 9 percent for home health care.

While the growth of total health spending slowed in 2008, Medicare spending increased at a brisk pace, rising 8.6 percent, to a total of $469 billion, the report said.

The overall increase in spending on hospital care was the slowest in a decade. But hospital spending for Medicare beneficiaries rose 7.7 percent, reflecting an increase in hospital admissions after two years of declines."

So here is my punch line: the loss of 1 million people from the rolls of the privately insured held private health insurance costs to a mere 1.2% growth rate. Even if we assumed that keeping these 1 million people privately insured would have added an additional 1/195 or 0.51% to private costs, this would have been a growth rate of 1.71%. Hardly as large as Medicare.

OR, to be really fair, even if we assumed that those who lost their private coverage were sicker and that as a group might have cost twice as much as everyone else, even then private costs would have only increased by 2.25?

Yet Medicare went up 8.6%!

8.6% at a time when private insurance only increased 1.2 to 2.2% depending on how you want to look/slice the data!


You will have to decide, but I might remind you to be careful to not buy any "spin spin spin".

And as you think on this, remember the two high level issues in this whole national debate are universality and cost control- separate but related issues.

What everyone seems to have forgotten is the whole universality debate is all about protecting people when their luck is down AND THEIR HEALTH IS FAILING.

Eliminate poor health and the issue becomes more and more the straw man issue I know it to be.

Do we want universality because we want protection when our luck is down?

Do we want good health?

If you had to choose, which would you choose?

On that note I will leave you with a question that was nicely framed in the following dialogue between two of my heroes in this whole national health care discussion. I will also point out these two men are agreeing and yet of oddly opposite political viewpoints, though I think Michael Cannon put it better:

Improving "population health" generally means "helping people live longer."
To paraphrase, Uwe then writes:
If helping people live longer were our objective in health reform, we could do better than universal coverage. But health reform is not (solely or primarily) about helping people live longer. It is (also or primarily) about other things, like relieving the anxiety of the uninsured.
I applaud Uwe for acknowledging a reality that most advocates of universal coverage avoid: that universal coverage is not solely or primarily about improving health.
Will Uwe go farther and acknowledge that, since universal coverage is largely about some other X-factor(s), that necessarily means that advocates of universal coverage are willing to let some people die sooner in order to serve that X-factor?"

I will repeat: "... are (YOU) willing to let some people die sooner in order to serve that X-factor?"

So here is my very simple question which I will leave you with"

Are you?

Are you really willing to die sooner yourself for whatever this X-factor is? Do you see that this applies just as much to you as it does to everyone else?

Think about it and remember the following graph, and where the US sits on this curve:


Thai said...


Dink said...

Every human being has the right to perfect kidney function.

What an outrageous statement, no?

How can a government (or private insurance)guarantee what genetics can not? But I suspect genetics isn't the main reason for differences in kidney function. Its lifestyle.

And I'll lose my mind if my vegetarian, non-drinking, non-smoking self has to pay for every former frat boy's dialysis.

And they idea behind a collective isn't touchy-feely generosity for kindness' sake; its that what benefits the whole benefits the individual. Public education for other people's kids totally benefits me so I gladly pay property taxes. But I'm not making the win/win connection with universal healthcare.

Vaccines, sure. Health care for kids, sure. Maybe even "catastrophic" events like car accidents. But not avoidable lifestyle diseases. I'll go insane paying for bariatric surgeries for people who haven't eaten a vegetable in six years.

I need to see some freakin' boundaries before I buy into this.

Debra said...

Dinky... WHAT do you have to say about the children who suffer from fetal alcohol syndrome, following your line of thinking ??
NO PUNITIVE REPRESSIVE SOLUTIONS ALLOWED as punishing people who most often don't have the money to pay (the parents) does not solve the problem OR benefit the collectivity.
Some tie-ins to your gripe, Thai.
A recent article in Salon by Glenn Greenwald... griping about the fact that our society has turned into an atomized bunch of lily livered individuals obsessed with entitlement, security, being taken care of, and "me me me" rights.
Not exactly the best way to foster a collective spirit of cooperation.
On the health care issue, and living longer, I earnestly thank J.K. Rowling for continuously pointing out in the Harry Potter series that the worst thing that can happen to you is NOT NECESSARILY to lose your life.
This debate is particularly poignant to me, and very instructive in the death penalty issue.
What would YOU choose, Thai, if for one reason or another you faced life in prison with no possibility of parole ?
Given current prison conditions in maximum security would you rather live in hell for an unspecified duration or opt for that death penalty ?
Check out Glenn Greenwald's article on terrorism/liberty in Salon. It is worth your time.
I am much more interested in living a FULL, VIBRANT and SHORT life than a dull, tedious, pablum life from which all risk has been eliminated in order to protect me.
Why not live a long, full life ? That is definitely the best solution.
But not everybody enters this world with the capacity to fulfill this aspiration.
And our ancestors' lifestyles continue to influence the outcome of our own lives. And WE are not responsable for the consequences of acts that we have not personally committed, EVEN IF WE MUST REAP THE CONSEQUENCES OF SAID ACTS.
These are very complicated questions.
But we have become a rather dull and stupid species, as a whole. We gripe about the fact that the above is true because it seems "unfair" or unjust to us. That is truly negative infantile behavior (not all infantile behavior is negative...).
We have become victims of our desire to oversimplify our lives. We have decided that since it is easier to decree that the quality of life = the number of years lived, we have dumbed ourselves down in order to collectively and individually believe it.
But.... it is not true. Not for one minute. And WE know it, moreover.
I think that I will probably not live very long.
Because I have a family history of heart disease from both parents. Because my mother had breast cancer. Because I went through several melancolic episodes without medication to diminish the pain, and that my cold turkey attitude will have negative consequences for the future.
But... I will definitely be able to say that I was alive. And NOT one of those hand fed lions playing with the baball in the Smithsonian Zoo.

Thai said...

I think my next post will be on non-linear systems and how linear thinking gets us into so much trouble in a non-linear world.

... Please understand I am 100% agnostic on the issue of universality: all things being equal, I certainly want universality, but I am simply not willing to have it if it means CERTAIN sacrifices are required... As far as I can tell, those sacrifices are now in fact being required.

Asking that we all live statistically shorter lives so that it can be accomplished is not a trade off I am willing to accept.

It seems to me the only way to achieve universal coverage and simultaneously not prevent others from spending their own health care dollars on themselves as they chose- I am not a big fan of telling people what they can or can't do- is to make health care cheaper.

And this is most assuredly the one thing we ARE NOT doing as a society.

It is much easier to ask people to suffer small burdens than large ones.

Yet our current system is asking that we suffer larger and larger burdens for an illusion and we are still not achieving the illusions promised land. Further we now want to restrict people's choices anyway, the very thing universal coverage was hoping to prevent since we did not want to restrict choices on obesity, killing, mental illness and "irrational"behaviors, cocaine use and suicide, HIV and sexual addiction behaviors, smoking, etc...

The very things which in composite are eating up the overwhelming majority of medical costs in the first place.

I do not see how anyone can see your ideas as a workable solution that a group of people can come to cooperate around- liberal or conservative.

And Deb, a couple of points:

1. re: blog ettiquette

If you refer to an article by someone, could you please provide a link as well?

2. re: we are irrational animals.

At some level: so what? That position justifies anything and is can just as easily be used by a tyrant who says "I feel irrationally happy about the idea of sterilizing all those alcoholic parents and their babies"- as was done in Sweden, etc...

Under such a system, it is just as easy to say "Hey we are irrational and it feels good so why not? More Lebensraum room for MY kids"

We may be irrational, but embracing our irrational side does not get us anywhere as it permits as many futures as my nihilism is.

In being irrational but embracing some degree of rationality, at least we then do all have to agree on something that we can all hold each other accountable to- even recognizing there will be times when the template breaks down.

It also allows "forgiveness four our trespasses", but sadly not all the time.

Anarchism is one possible future, but it is one that I think the overwhelming majority of people on this planet would actually fight to avoid, even with their own lives.

The risk-payoff makes sense under such circumstances.

3. If you are personally saying "yes, I want my X and I want a shorter life", you certainly have the option for shorter life under my rules. I do not have the option for longer life under yours however.
Of course the corollary is you do not get X in my option while I get X in yours.

Now we have a negotiation: which is really more important to you and we can trade.

I want more life. ;-)

And, you are forcing a shorter life on your children as well? Are you sure this is what you want?

Thai said...

One of the ways I like to think of this is as follows:

Many on Sudden Debt are offended by the misuse of CDS or credit default swaps and see the damage they are causing.

I agree with them.

I am also offended by the misuse of HDS or human default swaps and definitely see the damage they are causing.

I do not think doubling down and making the US government responsible for all human bad action will do anything but tear the collective apart. On this I certainly agree with you Dink.

So to solve this issue, universality will require that totalitarianism in it pure form by applied- you just have to love complex, non-linear systems and how messing with one part always messes with another.

As I like to say, a rose by any other name does not smell as sweet. All systems require their own form of totalitarianism but and my form of totalitarianism just smells sweeter to me than the actual thing.

Lot's of little day to day small difficulties forcing behavior changes which make one large difficulty far less likely.

The difficulty will always be there.

Thai said...

And I cannot say how I would decide were I imprisoned for life, I just don't know.

I do know the majority of people facing that choice choose life.

And I do agree with you if you are saying that people who make a humanistic/moral distinction between the death penalty and life imprisonment are being bizarrely "aesthetic".

To think one is better (and a sing of a more moral civilization) than another is doo-wack-a-doo in my opinion.

Europeans often attack American for maintaining the death penalty and somehow suggest they are more "moral" than us/we are less moral for choosing death over life imprisonment.

This is a straw man position if ever there was one.

Europeans are not face with the difficult decisions our courts and society are face with nearly as often.

We have more murders in a major city in America in one year than you do in all of Europe.

Thai said...

Deb, I re-read your comment and looked up a few Glenn Greenwald articles and I think I may be misunderstanding your point.

I certainly agree some people are not blessed with good genetics, but for most people, genetics is still as smaller role than environment when it comes to health.

Debra said...

Geez Thai, for someone who seems to be accusing me of being irrational, you sure went through a major irrational episode in those comments back there.
You know that we basically agree on most things, so why think that we are going to have a major disagreement here ?
I am not sure we are having a major disagreement yet, as you are sounding so... irrational that I am having a hard time following you.
I am going to pull the rabbis out of my hat here, and tell you my position.
Since you are a VERY VERY INTELLIGENT PERSON, Thai (and no, I am not the flattering kind...), you will have to extrapolate and deduce my position from the following.
The rabbis say that there are four basic positions that govern interpersonal relationships with respect to the question of property.
They are :
What is mine is yours, and what is yours is mine. That is the position of the... fool, an utopic fool.
What is yours is mine, and what is mine is mine. That is the position of the impious, unrighteous man. (We would say... SELFISH.)
What is mine is mine, and what is yours is yours. That is the... REASONABLE (should I say, logical and rational position ??) position, but it is also an attitude that sets the stage for war. It is the position of our modern democratic countries, and creates a society where everybody is constantly, surreptiously checking his neighbor's plate, yard, house, to make sure that HE HIMSELF is not getting shortchanged (see Dinky and "every human being has the right, etc etc). The Bible says that it is the position of the people in Sodom and Gomorrah who got wiped out by God...
And last but certainly not least...
What is yours is yours, and what is mine is yours.
That is the position of the righteous man.
Yeah, I know that it sounds like utopia but since the alternative is war without end, just when does utopia start sounding... REALISTIC ?
Pardon my poor blog etiquette, Thai. I just can't manage to get my head around posting links. One of these lifetimes..

Thai said...

My apologies, I did not edit and therefore sounded like a raving lunatic. ;-)

Thai said...

And by the way Dink re: "... I'll lose my mind if my vegetarian, non-drinking, non-smoking self has to pay for every former frat boy's dialysis."

This is the one thing that Hell has taught me is incorrect thinking: you really are not, even though I do find this hard to remember at times.

Kidney failure, etc... shortens lives and also require that healthy people care for those who are ill. This means that their total costs go down as they live shorter lives and that further those who are healthy earn more as their services are in even higher demand.

Remember how I said one cannot change the underlying structure of society- at least if the conservation of energy and Sugarscape are to be believed.

The frustrating thing is that we simply spend out resources making the world look like A and not like B.

Everyone on dialysis is very sad- a world that looks like A

Everyone off dialysis is happier- a world like B

Using resources to help people on dialysis means we cannot use those resources to figure out how to never have to go on dialysis.

It was always a choice and what we were willing to sacrifice to achieve.

Thai said...

Interesting article

Debra said...

Since I was revved up thinking last night, and I couldn't get to sleep, I'm going to address one of our major differences, Thai.
I regularly feel like you want to pull me over to a... VIEWPOINT (?) that I am not willing to stand at :
you regularly present your positions from the vantage point of the social body, and what is good for... it, on the topic of health care.
This is a viewpoint that I continue to.. shun.
I spent over twenty years of my life as a shrink.
A shrink's first responsibility is to his INDIVIDUAL patient, and my thinking necessarily privileges the individual's... interest, under the assumption that IF I privilege the individual's interest I am basically helping the social body AT MY LEVEL at the same time.
Let me challenge you another way Thai : what you say on this blog, like what I say, is basically talking outside of situations.
But... when you are in the ER room, do you see the individual faces, and are they your priority, or do you see your.. ideas ?
In my book, the doctor's responsibility is to see individual faces, and put in the impossible position of seeing ONE individual face, and the social body, and having to choose, he chooses... where his fidelity to the Hippocratic oath enjoins him to choose.
That is why I refuse to skirmish with you on this territory. Or at least, I hope I do. I am NOT a policy maker, and I have no inclination to make social, and institutionalized decisions.

The Most Fabulous Objects In The World

  • Hitchhiker's Guide To The Universe trilogy
  • Lord of the Rings trilogy
  • Flight of the Conchords
  • Time Bandits