The elephant in the room...

[elganned]

Okay, maybe it's time to bring up the subject that nobody wants to talk about.

What's really driving the skyrocketing cost of healthcare?

Partially it's a supply problem--not enough doctors. Medical schools in this country admit and graduate far fewer doctors than they could or should. This is deliberate, and should change. Admissions boards try to limit the number of their students, sometimes maintaining a staff to student ratio of 1:1 or 1:2. They justify this practice by saying it's the way to turn out the best doctors. It also accounts for much of the high cost of tuition at medical schools, another factor in limiting the number of doctors: who can afford it?

But this isn't the elephant in the room mentioned in the thread title.

The other part of the problem is the demand side--more and more services are being required and requested. In part this is due to factors which are addressed in other threads: third-party pay leading to no incentive to keep costs down, doctors being paid via fee-for-service, creating an incentive to jack up the bills with unnecessary procedures and tests, etc. But there is a third reason for the increased demand...the elephant everyone pretends isn't there.

It's old people.

When Social Security was introduced, average life expectancy was 67. The medical advances we've experienced in the last six decades have people living routinely into their 70's, 80's, and 90's. And old people, like old cars, require more and more maintenance as they age.

We have even been able to overcome conditions which even a few decades ago were almost always fatal--heart attacks, strokes, cancers of all kinds. But these "rescue" procedures are expensive. And they leave people alive to continue to accummulate expense.

Glaucoma. Cataracts. Hearing loss. Osteoporosis. Joint replacements. Advancing fragility, leading to more broken bones. Foot ailments. Arthritis. Circulation problems. Oxygen tanks. Chronic diseases which manifest more and more as we age and require more and more interventions and treatments. Pacemakers. Bypasses. Mechanical devices like treatment pumps, wheelchairs, walkers, lift beds and chairs...the list goes on.

It costs more every year to keep people alive and comfortable. Interventions become more and more elaborate, with concommitant greater costs. As medicine continues to advance, the population will continue proportionately aging. And the cost of keeping people healthy and around will continue increasing.

Healthcare costs as a percentage of GDP will continue rising until they are no longer sustainable. Yet we can't set up "death panels" to determine who gets to reach 80 and who has to check out "early".

I believe that this will be the greatest financial and moral challenge our children and grandchildren will have to struggle with, brought more sharply into focus by the retirement of the huge Boomer generation.

So in the end, we come to the Big Question: What are we going to do about Grandma?

Your thoughts, please. And be serious.

[Sstashmoo]

Fix the economy, slap restrictions on lawyers-Tort reform, investigate the medical profession for price gouging. 200 dollar aspirin and Doctors charging 1500 for poking their head in the door, and asking how you're doing.

[jams]

So on which birthday should we off ourselves? 40, 45, 50...?

...and I am serious.

[sirrealone]

I think elder care has a part in rising costs. I also think specialized care has a big part in it. Many types of cancer 20 years ago was a death sentence. Today, we'll spend a million dollars and beat it.

I don't really have a problem with either of these. As medicine advances, we have more opportunity to extend people's lives and give them more productive years.

However, there is really a problem with costs that fall outside of these areas, and let's face it, the majority of people in America fall into the 'routine' type of care receivers.

My family consists of me, a 35 year old male, my wife, a 27 year old female, and our son, who is four months old.

Things we went through this year: My wife's prenatal care and childbirth, my son's newborn care, my wife's dermatology visits for acne, my dermatology visits to address a skin rash and to remove moles, and my wisdom teeth removal.

The out of pocket costs for all of this will, for the year of 2009, probably be $2,500. This is in addition to having roughly $5,000 deducted from my pay to cover the portion of insurance that my employer doesn't cover.

Next year, that $5,000 figure will go up by at least $1,000 since the costs for this year were lower until my son was born. So, at a minimum they'll be $6,000 and will most likely go up at least 10% which seems to be the yearly average And coverage is expected to decrease, so even though my wife won't be having a kid next year, the out of pocket costs for our family will probably be around $2,000.

So with those types of increases for a family that doesn't have elder care and doesn't have specialized care, there is still a fundamental flaw somewhere. And it's unsustainable. I consider myself lucky that I make a good living, but I've considered myself to have net pay decreases for the last five years, because any salary increase I've received has been offset largely by increased costs for medical insurance.

I think trying to pin this on the elder care argument is flawed. There is a much bigger problem that needs to be addressed before we can go there.

[gnome]

Ice flows...do it Obama-style.

It's not the elephant I'm worried about, it's the poo.

[gazhekwe]

Seriously, that IS the question. We need to plan for the population. Baby Boomers are an inevitable tsunami, supported by fewer people than needed according to the original planning. Not only will the Social Security and Medicare systems be inundated, but there will be insufficient services in geriatric medicine, counseling and planning. Residence needs will change in waves as the baby boomers age. No, they do not want to accept the aging process, but as its inevitable inroads advance, they will be forced to use services and residence facilities as their needs arise.

Therein lies opportunity! The trick is, wedding the opportunity to the costs. Should we have a use tax on geriatric services and housing to support increases costs? There is some precedent there, as employer taxes have supported things like workers compensation and unemployment.

Some of the opportunities
Residential/retirment living facilities
Modification for living needs in existing homes
Medical and adaptive equipment
Insurance for assisted living and in home care
In home care assistance
Financial counseling
Case management
Geriatric psych
Geriatric medicine
Bill paying and money management assistance
Transportation assistance

[Blueidone]

I don't think that's what was being proposed. But review the following true story and see if there isn't some validity to the point made:

My father is 93 years old. Four months ago his doctors suggested that to alleviate his back pain he should have a spinal fusion on for disks in his back. There was some discussion in the family whether he should go through such a radical procedure at his age.

My father was an avid golfer throughout his life. It was NOT the back pain that made him stop golfing, but the macular degeneration that he suffers. He cannot drive anymore. He suffers from major hearing loss, but is too vain to wear hearing aids. Other than these issues, he is generally healthy.

The alternative was for him to continue receiving epidural cortisone injections in his back to alleviate the pain. Which, by the way, is what I have had done for my back pain. After much discussion with my siblings and I, Dad went back to the doctor to ask more questions. So what did the doctor tell him to convince him to have the surgery?

Quoth the doc, "If you have this spinal fusion, you will be able to golf again before the end of the year."

So, of course, Dad said, "Ok, let's do it!!"

Nevermind the fact that he can't SEE the ball to swing at it. Nevermind the fact that he hasn't played golf in about 5 years. Nevermind the fact that he can't drive to the golf course, or drive the cart.

So thousands of dollars were spent to pay for a surgery that has not yet significantly improved his life. The pain in his lower back is gone, but now his upper back is hurting all the time. He still can't go anywhere. He still can't play golf. He still sits in his apartment looking out the window or watching TV. The pain could have been relieved without the surgery.

I love my father very much. I hope he lives many more years. But he did NOT need this surgery. I know it, the doctors know it, the nurses in the hospital knew it. But it's easy to convince an old man that he can regain some sense of his younger days.

Don't get me wrong, I don't believe that there should be a "stopping point" for anyone. I believe it should always be a decision between a patient and his/her doctor, not some bureaucrat or politician. However, there is waste, there are unnecessary procedures, there are doctors who push a surgery when other methods will do.

This constant barrage of advertising medicines on TV and in magazines just makes some people, especially the elderly, think they have a new disease or need a new medication. I have even seen advertisements for companies who make parts for joint replacements. And we all know how strong the lobbyists in this area are.

I don't know what the answer is. It seems like we are on a merry go round that is going too fast and won't stop. Hopefully there are people out there who can figure out how to end the madness.

Ok...I'm done ranting now...

[rb336]

Fix the economy, slap restrictions on lawyers-Tort reform, investigate the medical profession for price gouging. 200 dollar aspirin and Doctors charging 1500 for poking their head in the door, and asking how you're doing.

tort reform is pure red herring -- maybe 2-3% of costs if that. medical law suits have one of the highest dismissal rates. it's another means for the insurance industry to screw us.

[elganned]

Fix the economy, slap restrictions on lawyers-Tort reform, investigate the medical profession for price gouging. 200 dollar aspirin and Doctors charging 1500 for poking their head in the door, and asking how you're doing.

All of which will accomplish...what? Stopping people from getting old--and older? Reduce the number of elderly that need care?

You failed [[yet again) to address the question, which is: How will we pay for the high-and-inevitably-going-to-get-higher cost of caring for our elderly?

[elganned]

Ice flows...do it Obama-style.

It's not the elephant I'm worried about, it's the poo.

Thanks for being serious.

Do you have anything substantive to contribute?

[elganned]

So on which birthday should we off ourselves? 40, 45, 50...?

...and I am serious.

I don't think it's a set date. For some it will be sooner, some others later.

I personally think that when I can no longer do the things I enjoy, I wanna check out and move on. No sense waiting around the station after the train's pulled out.

My father had a massive stroke when he was 57 and lived the next 20 years as a mere shell of his former self, unable to work or write or play cards or hold a halfway coherent conversation. I don't want that.

[ejames01]

Logan's Run

[Ray1936]

Hey, dickheads, I'm 73.

With thinking like I see in some spots up above, I see it's time for me to write down the Bucket List. And I better hop to it.

[elganned]

I think trying to pin this on the elder care argument is flawed. There is a much bigger problem that needs to be addressed before we can go there.

I agree, and stories like yours is what I'm sorta looking for. I'm not trying to "pin this" on elder care, but I do think that elder care is a significant part and will inevitably drive the debate in the end, if not now then at some point in the future. It will only grow bigger as a slice of the cost pie until it dominates all else.

Thanks for your response. Do you have any thoughts as to what we can do to deal with the elder care problem?

[elganned]

Seriously, that IS the question. We need to plan for the population. Baby Boomers are an inevitable tsunami, supported by fewer people than needed according to the original planning...Therein lies opportunity!

Gazhekwe, I wasn't so much looking for suggestions on How do we make money from this? as I was thoughts on How do we pay for this? Because we're all going to end up in this boat eventually.

[elganned]

Hey, dickheads, I'm 73.

With thinking like I see in some spots up above, I see it's time for me to write down the Bucket List. And I better hop to it.

Insulting people won't change the facts, Ray. Try to be a little more constructive.

[sumas]

This is a serious reply to your questions. I am mid fifties, my husband, slightly older. Seven years ago his employer canceled health care insurance and six years ago my employer canceled mine, due to "costs". Costs we could not absorb in our budget.

No dental, no health care...period. It is a different kind of genocide.

My Mom will be ninety in January. She is in great shape due to good health habits and great and I mean great health care insurance.

I feel like the elephant in the closet. It seems to me that federal social services just want to see us fade away. No old folks, no pay outs.

Bitter, you bet.

[Thames]

When my son was born, everything was done in the LDR room [[labor, delivery, recovery), however, when the bill came we were charged for a surgical suite. It added a huge amount to the bill. When I inquired, I was told we were being charged because it was available to us in case we needed it. There were about 6 babies born that night, all normal deliveries [[no c-sections). The hospital must have made a fortune just on that one night. Charging everyone for the surgical suite that no one used.

[gazhekwe]

elganned, people are going to make money. How about figuring out a way to siphon off some of those profits to help pay for the expenses? It is common enough. For social security, we all pay a share, same with Medicare, Unemployment, workers comp.

[ronaldj]

We are all going to die sooner or later. Spouse and I joke that we will not make it past seventy. No health care. No dental care. No life insurance. P/L P/D on the car. Baby boomers go BOOM.

[sirrealone]

I think that the real elephant in the room when it comes to the health care costs are people that live unhealthy lifestyles.

Because, when it comes down to it, people get old. There's no getting around that and if we can accept the costs that go along with that and be realistic about them, then we might get somewhere. We've known the census reports for the last 60 years. It should come as no surprise that a bunch of baby boomers are suddenly going to get old all at once.

So, yes, we cannot control getting old, but what about the costs associated with unhealthy lifestyles? Doesn't it seem a bit off at all that a person under group insurance pays the same whether or not they live healthy. A person who doesn't exercise pays the same as someone who stays fit. A person who eats fast food eleven times a week pays the same as someone who indulges maybe once a month. A person who doesn't smoke and avoids secondhand smoke pays the same as the two pack a day guy in the next aisle over.

I live a pretty healthy lifestyle. I'm not perfect, no, but I exercise a few times a week, I eat fruits and vegetables, I don't smoke. Yet when it comes to group coverage, I'm paying the same as the guy that goes out and gets a double combo meal from Wendys every single day for lunch. You don't think that I'm subsidizing him? You don't think that if his insurance premiums went up because he was judged unhealthy that he might consider some lifestyle changes?

And the sad thing is, that those people are going home and bringing the KFC bucket and teaching their kids the same bad decisions and worse. Oh, but it's OK because they brought a side of mashed potatoes, right?

Give me a break. I personally blame a big chunk of the rising health care costs on unhealthy living that is so common here in America. We can't hold people accountable for getting old and having your body break down. But there has to be some accountability for how you treat your body if there is ever to be a true fix of the system. Does any proposal you hear have any type of accountability factor? Of course not. Because Obama, every Senator, and every Representative know dam* well that if they start calling out the fatties and the smokers and the couch potatoes, they're committing political suicide. So instead we ignore lifestyle like it's not a problem, when I think it's the biggest thing standing in the way of controlling health care costs.

[rb336]

elganned, people are going to make money. How about figuring out a way to siphon off some of those profits to help pay for the expenses? It is common enough. For social security, we all pay a share, same with Medicare, Unemployment, workers comp.

certainly -- we should get rid of the cap on medicare and soc sec so it isn't the single most regressive tax on the planet

[Pam]

Give me a break. I personally blame a big chunk of the rising health care costs on unhealthy living that is so common here in America. We can't hold people accountable for getting old and having your body break down. But there has to be some accountability for how you treat your body if there is ever to be a true fix of the system. Does any proposal you hear have any type of accountability factor? Of course not.

I thought some of the proposals did. [[Can't cite anything off the top of my head, but I thought I heard it mentioned.) Even some insurance plans now have incentives for joining gyms or offer "wellness coaches" and such.

[elganned]

sirrealone, the problem with attacking "unhealthy lifestyles" is that there is no way in a free society to monitor a lifestyle.

How are you going to ensure that people are following a healthy lifestyle? Require that they register all of their grocery purchases with the insurance company? Provide proof that they walk two miles every day? Have spot check-ups by public health officials, like random road stops to enforce seatbelt usage? Any such provisions would be utterly unenforceable and untraceable.

Unless, of course, you force people to live in internment camps where everything they do and eat is controlled and watched by an outside force, be it government or insurance companies or whoever. That goes 180 degrees counter to a free and open society, and no one would stand for it.

[elganned]

We can't hold people accountable for getting old and having your body break down.

That is not what I'm suggesting or asking. The question is not "who do we hold accountable", but rather how do we pay for the inevitable health problems associated with advanced age when that age limit continues to move outward and the total number of aging people keeps increasing.

More people are living longer. That's a good thing. But in order for that to happen, more and more money is and will be spent on keeping them healthy while they are alive, especially at the end of their run.

The latest estimate I heard was that up to 30% of the Medicaid budget goes for healthcare expenses of people in their final two years of life. That's an enormous chunk of change, and it's only going to get bigger.

It's not people's fault that they get old. We're all going to get there eventually. The question is, how do we pay for it?