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.

[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?

[mauser]

Doctors charging 1500 for poking their head in the door, and asking how you're doing.

That would be the insurance company at work.

Tort reform ? That is code speak for removing more rights from citizens. Being able to sue the hospital or doctor because they did some horrible botched job is just plain basic democratic protections. Anything less drifts us further towards a corporate fascist state.

AMA needs to allow more doctors per year. That is artificial wage inflation, and can be stopped with simple regulations.

Insurance companies burn up the largest percent of health care costs in pure bureaucratic administration. Anybody who attempts to argue about the condition of health care in the United States without admitting that the insurance industry is the # 1 reason for its collapse is just lying.

Insurance companies are also the primary force behind the foreclosure crisis. The majority of people losing their homes right now are failing because of medical bankruptcy.

It is a fact. Half the cost of healthcare could be eliminated over night. Just sign one law and do away with the entire immoral industry of health insurers.

You can still have private insurers for health like other more advanced countries have, just not the ones we have here. Those existing American companies need to be shredded and scattered to the winds.

[elganned]

You can still have private insurers for health like other more advanced countries have, just not the ones we have here. Those existing American companies need to be shredded and scattered to the winds.

So you kill one dog and get a different dog. What makes you think he'll act more like a horse? He's still a dog, and will do what dogs do.

[mauser]

So you kill one dog and get a different dog. What makes you think he'll act more like a horse? He's still a dog, and will do what dogs do.

My comments are based on studies made of every single other industrialized nation on earth, who all provide insurance to every single citizen.

The FACT is, that many of the top ranking countries health care plans are private or half private. The private versions work very well under tight regulations.

It is not private health care that is the problem.

The problem is a government which is no longer based on protecting its citizens. Plain and simple.

Our government is currently designed to protect corporations from citizens.

And yes, I will say again - the CURRENT private medical industry companies which launched this assault on the American economy, and have as a result caused the greatest loss of wealth in US history via foreclosure due to medical bankruptcy - those companies must be put to death and dismantled permanently.

Same goes for the oil companies.

And telecommunication.

Here are the tools:

http://en.wikipedia.org/wiki/Glass-Steagall_Act

http://en.wikipedia.org/wiki/Sherman_Antitrust_Act

[oladub]

That would be the insurance company at work.

Tort reform ? That is code speak for removing more rights from citizens. Being able to sue the hospital or doctor because they did some horrible botched job is just plain basic democratic protections. Anything less drifts us further towards a corporate fascist state.

Calculating what doctors pay for malpractice insurance and pass on to patients who in turn have to purchase more expensive policies, I roughly calculated that your cherished right to sue is costing everyone 7%. Insurance companies are the biggest beneficiaries. President Obama would be sainted if he could just wave his magic economic wand and make US healthcare 7% more affordable but he refuses to. The rough 7% number does not include redundant and unnecessary tests doctors do to protect themselves from lawsuit. Nor does it include huge savings from reducing an administrative work force necessary to process all the insurance paperwork.

Canadian provincial single payer systems include tort reform which hugely reduces the cost of maintaining parasitic lawyers, insurance companies, and paper shufflers, who cure no one, from their plans. This is a major reason why Canadian provincial plans are affordable.

AMA needs to allow more doctors per year. That is artificial wage inflation, and can be stopped with simple regulations.

True, except it probably costs $200,000 to train a doctor if the student only has to pay half that much. That cost could be trimmed if doctors didn't have to earn a bachelors degree first taking only pre-med cources before med school. States, through land grant colleges, could offer reduced price med school educations if the student would stay in state and work at specified wages in certain locations for a given amount of years. This way, more med students could afford medical training and the state would get all of its money back and the poor would be better served..

I would go further and allow a tiered doctor program. This is being done to a limited extent now. Make it easier for nurses and experienced army medics to qualify themselves for routine doctor work and proceedures. This would reduce the need for more doctors and make health care more affordable.

[elganned]

True, except it probably costs $200,000 to train a doctor if the student only has to pay half that much. That cost could be trimmed if doctors didn't have to earn a bachelors degree first taking only pre-med cources before med school.

It could also be trimmed if medical schools would admit more students. Some med schools currently hold their student to staff ratio as low as 1:1 or 1:2; student populations could easily be expanded with little or no loss of quality.

States, through land grant colleges, could offer reduced price med school educations if the student would stay in state and work at specified wages in certain locations for a given amount of years. This way, more med students could afford medical training and the state would get all of its money back and the poor would be better served..

Excellent idea. A sort of "GI Bill" for med students. It could also be implemented at the federal level, but this would probably be denounced as "socialism". I understand your emphasis on states taking the initiative, given your constitutional proclivities. In any case, whoever implements it, it would go a long way to expanding the number of doctors, providing competition with a consequent lowering of cost.

I would go further and allow a tiered doctor program. This is being done to a limited extent now. Make it easier for nurses and experienced army medics to qualify themselves for routine doctor work and proceedures. This would reduce the need for more doctors and make health care more affordable.

Excellent thoughts, all of them. Thanks, oladub.

[jams]

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

...and I am serious.

[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

[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.

[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?

[gnome]

Ice flows...do it Obama-style.

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

[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?

[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

[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.

[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...

[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]

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.

[jiminnm]

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

Wrong response elganned, Ray's is probably the most cogent of all here. I am probably closer to Ray's age than yours, so I write from that perspective.

oladub's comments on tort reform are spot on but, of course, tort lawyers are a major contributor to Dems and a powerful lobby, so we won't see that soon.

You can save money by squeezing payments to health care professionals even more. Of course, that will mean fewer folks enter the profession and getting health care will become more difficult. Since private pharmaceutical companies develop about 85% of drugs on the market [[with the Feds developing about 15%), fewer drugs will become available and folks will die. It's not overt rationing, but the result is the same.

Obama says that some of the funding for any new programs will come from eliminating fraud and corruption in current programs. If that much is there, and I think it is, why isn't it being addressed today? So, I see that comment as either an admission of incompetence or simply a lie.

You could require folks to show identification and proof of legal residence prior to receiving government paid health care. But, the Dems keep nixing that idea. Yes, I know, that current proposals have included language prohibiting the use of federal funds to provide health care to illegals. That language is meaningless, however, when you prohibit those providing the service from asking, and as long as no one can ask and they don't tell, care will be provided and money spent. It makes one wonder of theis isn't really a health care bill at all, but another way to encourage more illegal immigration and more future Dem voters. We'll know more on that whenever obam introduces his immigration bills.

The real savings, however, would come from elsewhere. When it's eventually determined that the new program can't come close to being funded without substantial tax increases on everyone, amd I mean everyone, then folks will start looking at where the costs are incurred.
Numerous studies have stated that, on average, 75-80% of a person's lifetime health care costs occur in the last 12-18 months of life. If one's most critical concern is to save health care costs, than simply eliminate that spending. That's the idea that has millions worked up about what the practical effect of the language in HR 3200 might mean.

Since most of you will be paying for this program long after Ray and I, how much you willing to pay yourself, or willing to give up, to get it?

[elganned]

Wrong response elganned, [to Ray1936] Ray's is probably the most cogent of all here. I am probably closer to Ray's age than yours, so I write from that perspective.

No, I think it was entirely the right response. Regardless of your opinion, prefacing your remarks with "Hey, dickheads" does little to further the discussion in a thoughful and mature manner. The question wasn't posed to be adversarial, but to explore serious answers. His wasn't, and received the consideration it merited.

Since most of you will be paying for this program long after Ray and I, how much you willing to pay yourself, or willing to give up, to get it?

The remainder of your post deals with the present discussion about healthcare reform and how to pay for it, which was not the topic under consideration. So I'll restate it:

People are living longer, and there are more of them. Regardless of whatever plan is put into place, that trend will continue.

A century ago, most of the 70-year-olds now walking around would already be dead. Dead people require no health care, and the young and vigorous require little, and that only occaisionaly. So health costs remain low.

But each year we extend life expectancy adds incremental cost to overall health care as a percentage of GDP, irrespective of who pays for it. So the question is: How do we deal with this phenomenon? It is happening, and will continue to happen, and sooner or later it will become a major problem.

Numerous studies have stated that, on average, 75-80% of a person's lifetime health care costs occur in the last 12-18 months of life. If one's most critical concern is to save health care costs, than simply eliminate that spending. That's the idea that has millions worked up about what the practical effect of the language in HR 3200 might mean.

I suppose that would be a practical sort of solution, if we could accurately predict when that 12-18 months is going to occur in each situation. But we can't. The best we could do might be to establish an average age at which it would most likely happen [[actuarial tables) and then set that as a "cut off" date: on your 80th birthday, you kiss your family goodbye, eat your cake, and call Dr. Kevorkian. Draconian, no doubt, but efficient and effective. [[Soylent Green, here we come...)

I don't want to go the way of "death panels", nor do I think anyone here does. So we'll have to think of something else. I'm asking if anyone has any ideas on what that "something else" might be.

Perhaps we should shift all of our medical research resources into finding some way to prolong vitality as well as extending lifespan. I don't know, maybe that would work. Maybe not.

What I do know is that, maybe in my lifetime, certainly in my children's lifetime, if we don't attack the demand side of the equation somehow there won't be enough money in the economy to keep everybody healthy. Every able-bodied person will be manning the pumps to keep us from sinking, and there'll be no one left to sail the ship.

[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.