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Some Disagreements With DrewM Over End-of-Life Care August 10, 2013

Posted by geoff in News.

If you knew you were going to die in the next year no matter what you did, how much money would you spend on medical care?

Not much, I’d guess. But the problem is, you usually don’t know beforehand – the medical care you get may allow you to live 10 more years, or it may do nothing at all.

My dad, for example, had a spate of health problems when he was 63. Pulmonary embolism, blood clot in his leg, and gastric reflux surgery. Everything was going to hell. But he went through it all and lived another 15 years very happily and reasonably healthily.

If he had died, though, he would have been a Medicare statistic. You know – the one where they say that spending is 6X higher in your last year of life. But this is a stupid stat, and I’ll tell you why.

Let’s say that you’re a senior citizen who typically spends $2K/year on health care, but every 5 years you have some serious issues that cost $20K. Every 5 years you don’t know if this is the Big One, or if this too, shall pass, so you spend the money. It turns out that after the 3rd crisis, your time on the mortal coil is up – how do the stats look?

Well, your spending/year for the years you didn’t die was (12*$2K + 2*$20K)/14 = $4600/year. And your spending for that last year was $20K/year. So you were 4.3 times more expensive in the year you died than the years you lived.

Is that a meaningful stat in terms of guiding future expenditures? Not at all. You spent the same amount twice before and it paid off – why shouldn’t you pay it the third time?

Which brings me to DrewM’s post at AoSHQ. Drew says that he understands the math associated with increased cost for last-year-of-life care. I would submit that he doesn’t, or he wouldn’t have bought off on the “last year is the most expensive” argument.

This is not to say that there aren’t horribly inefficient or abusive practices in end-of-life medical care. It’s probably very tempting for practitioners and administrators to reduce patients to cash cows once they’ve given up on their prognosis, shuffling them about to extract the most from the Medicare payment system. But trimming those costs isn’t the real issue here – the real issue is denial of treatment because some panel is guessing that it’s not cost effective.

I also have a beef with this statement:

And spare me the, “I paid for Medicare all my life! It’s mine!”. It’s not true.

Here Drew misinterprets the New York Times article he links, but probably because their presentation was pretty unclear in the first place.

Revenues for Medicare come mainly from 3 places: 1) Medicare taxes (you’re paying those); 2) General fund (income taxes – you’re paying those); and 3) Premiums (you will pay for those). Drew is making the liberal mistake of assuming that Medicare money is coming from the Magic Money Pot that is the government. But we pay for all of that.

That all said, I don’t disagree with his conclusion, which bears repeating here:

That’s the true aim of ObamaCare…to remove that “inequity” (unless you’re a member of Congress or one of the other privileged classes in our brave new world). Now you selfish bastards can no longer spend your own money on yourself as you see fit. You will be forced to pool your resources so that we all may be equal. Naturally, “equal” will be defined by the experts in DC, who won’t be subject to their own brand of “fairness”.

Oh, Harry Reid says ObamaCare is just the first step to single payer.

But trying to defund/repeal ObamaCare isn’t the hill to fight on or something.


1. thirdnews - August 10, 2013

If I knew absolutely, I would hope that I would kiss reality but the experience of a friend’s death, tells me that we all make a deal with self-deceptiveness.

As for paying for the treatments, I want it funded but when a doctor orders repeated mammograms on a woman in the last stage of Alzheimer disease (I read about a case and IIRC, the poor thing freaked-out), the physician and hospital should be subject to financial punishments -if not lose their licenses

The Medicaid/Medicare fraud is vast, and till we criminally and financially punish the culprits, the ‘waste of money and resources’ argument with respect to that ‘one person’, who wants to go all out for a chance at another 15 years, or even less than a year, is moot.

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