We toldcha what was about to happen: “ Dec. 31 (Bloomberg) — The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little. More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.” From here: http://www.bloomberg.com/apps/news?pid=email_en&sid=aHoYSI84VdL0
You wanted him and this horrible bill. Now the seniors will pay more and more and …, and the bill hasn’t even been passed.
Those who think this will not dramatically effect the 2010 elections are living in a dream world.
CoRev said: “You wanted him and this horrible bill. Now the seniors will pay more and more and …, and the bill hasn’t even been passed”
CoRev has his conclusions and he’s sticking to them, regardless of the facts. And the facts are that the Mayo Clinic supports the HCR moving through Congress.
Mayo Clinic Encouraged by Senate Health Care Reform As leaders in Washington work on the final details of the health care reform plan, Mayo Clinic remains firmly committed to reform now more than ever. As we’ve said before, the status quo is simply not an option.
Since its inception over three years ago, the Mayo Clinic Health Policy Center has focused on reforming health care to improve access, quality and affordability for all patients. This remains the lens through which we examine all proposed reform legislation. The goal of health care reform should be to create a health care system that provides all Americans with better care at lower cost.
Much in the Senate Manager’s Amendment is aligned with our recommendations— including provisions to pay for value in health care, an insurance exchange, an individual mandate, subsidies for people to achieve coverage, and pilot projects on accountable care organizations and bundling of payments.
CoRev: You must either be very rich or very silly to worry so much about the welfare of the super millionaires. If you are one of them, of course you’d worry about every $100,000. But if you are not, one wonders why you find it so terrible that they might find a wee little dent in their multimillionaire incomes, etc. Odd. Perhaps you just hate poor people for some reason. Have they attacked you in some way?
And of course, one doesn’t have to use the Mayo facility in Glendale. It is not the only family medical center in the area. So odd how people so hate anything done for the poor in the USA. So many Americans seem to have abandoned all Christian virtues and taken on a kind of quais-Nazi super selfish barbarianism of attitude.
I believe the Nazis had universal healthcare. Its also my understanding that under the Nazis the German system became more controlled by the federal government.
It’s true that the Mayo Clinic Health Policy Center is supporting healthcare reform including the Senate bill. Let’s tell the rest of the story. What did the Mayo Clinic say about the Medicare system in the same policy brief?
They stated this:
“Senate leadership made a wise decision to drop plans to expand Medicare eligibility. We also applaud the Senate for not pursuing a Medicare‐like, price controlled public option. As we’ve said, we must build health care reform upon what’s working… not on a failing Medicare system.” …”There is still much to be done. Most importantly, Congress needs to find a permanent fix to the physician payment system so that our nation’s doctors can provide full access to health care to Medicare recipients in all regions of the country. Lawmakers must move Medicare toward a system that pays for value rather than instituting across the board reductions to doctors and hospitals, which will harm the high quality, lower cost providers the most.”
Economic Predictions 2009 (aka reasons not to quit your day job)
1. Economic recovery in second quarter 2009 (defined as positive real GDP growth) (near miss) 2. Unemployment Max: July 2009, 8.7 percent (low) 3. Stock Market: December 31, 2009 — 11,500 (Dow) (high) 4. OIL (WTI 1st nearby) December 31, 2009 — $65 (low) 5. $100 billion intrastructure stimulus (2009/2010) (low) 6. Rod Blagojevich beats the rap (appoints senator) (1/2 right other undecided) 7. Britney Spears makes comeback in 2009 (Correct) 8. Yankees win 2009 world series (correct) 9. No tax hike (or cut) 2009 (correct) 10. No Israeli/Palestinean peace plan (correct)
MM, super millionaires????? Most elderly are far from rich. For many Medicare is their only source of medical treatment payment, and you want to make some silly comment about super millionaires.
So you somehow don’t want Medicare expanded to more people? You didn’t want a public option that would have given Medicare like benefits to many many more. Most of your posts seem to come from the far right that basically reflects the viewpoints of the rich. If you aren’t rich, why are you so opposed to legislation that aims to help those who are not rich. You don’t want to be helped, or see others helped?
MM, adding more patients to a system that is failing is your solution for correcting what?
Yes, I am a conservative. I believe Govt is not efficient so more of it adds more inefficiency. Want me to enumerate the efficient parts of the Fed Govt?
I also believe that most are capable of making some contribution, but that all are responsible for their well being. For the very small portion of our population that is incapable of that contribution that provides for their well being there are already multiple programs.
So my view points do not reflect those of the rich, but those of the largest political segment of our country, the conservatives.
We need to tax the rich since they are using their extra income to destroy the advocate the destruction of the federal government and the enslavement of the poor and the middle class. The right talk about “class warfare” whenever there is talk of increasing the tax on the rich while the rich are actively pursuing “class warfare”. Taxes on the middle class go up ever year because of AMT and the increase in the “social security” limit. Taxes from the poor and middle class via income tax, social security and medicare provide the lionshare of the federal revenues for years. The rich who have most of the national assets and income have paid less and less taxes while the right are fighting to reduce their taxes to zero while increasing the tax burden on the middle class. This is why the right say Social Security and Medicare are broke without mentioning that the federal government owes the programs trillions of dollars. The right is either looking to destroy the programs or increasing the social security tax rate so that the middle class can pay an even larger portion of federal government expenses.
Contab and CoRev broach the class warfare line when some one aside the rich seem to be developing a spine to get a share of the fruits of nature and labor.
As a Mayo Clinic Emergency Medicine Provider, and an advocate for the Mayo Clinic Health Policy Center, let me just state that we are supportive of the current HCR legislation. We are not supportive of things remaining the same. Medicare however, is flawed on so many levels. Mayo Jacksonville has already had that same policy in place. Medicare’s reimbursement structure is so flawed, especially as pertains to primary care, that many physicians no longer accept it. I remember reading a study of a major hospital in NYC, and after surveying the hospitals 90+ internal medicine physicians, they found that only 27 accepted medicare. Medicare needs to change it’s payment structure from one that is focused on paying for procedural medicine, to reimbursing more for cognitive medicine, which is what primary care consists of.
Instead of paying for quantity, and encouraging physicians to do more procedures and more tests to be paid better, the focus should be on paying for QUALITY, and paying for a physician to tell a patient “NO, you don’t need that test or operation”. Right now, it is simply too flawed to continue in it’s current form, which is primary care physicians are avoiding medicare patients.
If a poor medicare patient cannot get health care that person should not enjoy the US’ nuclear umbrella either.
Delivery of medical services is not a market.
The sick mostly folks who are not trained physicians have no market power nor ability to assimilate and use information related to their “economic” decisions.
Except for the wealthy, and retired federal employees and military members with employer based medical insurance for life.
It is wrong to disregrad the needs of a sick man only because of that man’s ability to get funding for the service.
Unfortunate for Mayo to spread such swill.
If you get sick, die fast and cheap!!
What does Palin say about Mayo running a death panel?
MH, how do we measure quality on a per visit basis? Yup, you Mr Patient are free of cancer. Thanks be to my great care! That’ll be $3,500. Submit my bill to the Govt panel.
As a Mayo Clinic Emergency Medicine Provider, and an advocate for the Mayo Clinic Health Policy Center, let me just state that we are supportive of the current HCR legislation.
That makes sense since the current legislation today is focused on demonizing the insurance industry rather then proposing to restructure the way actual medical services are delivered and priced.
Cantab, we are supportive, this does not mean that we think the legislation is perfect. But, Congress simply cannot complete all the restructuring needed in fell swoop. The bill could certainly be improved, but it is a start.
There are many potential quality measures. We need to establish pay for value initiatives, and for those institutions who are providing quality care (outcomes measured), and doing so at a lower cost, they should be reimbursed at a higher rate. For those institutions who rank highest in costs, but whose outcomes are mediocre, or lower, well, you get the picture.
Personally, and I am not speaking for Mayo here, I am a fan of the Prometheus payment system. A sort of capitation if you will.
I’m not at all supportive of the current legislation. I think that any new system has to put the incentives on individuals to drive down costs. Although I don’t know how to get there but we need to do even more testing and monitoring for those that want it which means we need to drive down the average costs for tests and procedures while at the same time driving down total costs for the system as a whole. Basically I want more healthcare services for much less cost. Pie in the sky? I don’t think so. Look at the fall in the price of a new computer, oil exploration, agricultural products, or the production of just about any other commodity. They all have been falling, except for the two problem products — medicine and higher education. With the development and expansion of information technology there is no good reason the prices on these products to stay up.
Cantab, I am not an economist, although I have completed a lot of undergarduate economic work. Correct me if I am wrong, but Healthcare costs have relatively low price elasticity scores, correct? Suggesting that they are relatively inelastic. Utility costs are also rising, and they are to a degree inelastic as well by my understanding. I think that you have the right idea, but the completely wrong focus. We DON’T need to do more testing and monitoring. The point is, that much of the testing, treatments, and medical care is wasteful. This was highlighted in the Dartmouth Medical Atlas, and then later in the Gawande article.
We need to provide BETTER care, not more care. Lastly, and again, this is me speaking, and NOT Mayo, but we need to move to a system of rationing.
Does an 85 year old with end stage renal disease and multiple comorbidities need dialysis?
Should a 92 year old get a coronary bypass?
We need to look societally at cost vs benefit. I simply do not see an possibility of MORE healthcare services for a lower cost. It won’t happen.
I guess it depends if you’re that 85-year-old with renal disease, or the 92-year-old with a bad heart, and you haven’t yet become a vegetable. Just because your body has aged, doesn’t mean you aren’t human any longer.
Never said that you aren’t, but how about conservative treatment? There are always alternatives, but I think that doing a CABG on a 92 year old is scandalous, and wasteful. I actually wrote an editorial about this very topic this past summer. We need to pay for physicians to provide GOOD care, and sometimes that means (gasp) not doing a surgery, or procedure, or maybe NOT doing a test. Instead, we have a system that rewards ME as a provider for ordering more, more, more.
I had this very conversation with a patient the other day, who was very concerned about her condition, and wanted a “CAT scan”. I told her that I didn’t think that it was necessary at this time, and refused to order it. I’m sure she probably went elsewhere, and got it, even thought there was really no indication clinically for it.
But the cost of the manufacturing equipment to build the computer, the cost of building a place to put it, and anything else that is not a commodity contrinue to rise.
I work in a high-tech service industry. It may yet be affected by commoditization, but do we really believe health care delivery will ever be?
What due diligence does a social contract owe the old and the poor. When is a society negligent toward the helpness and needy?
What authority has a medic to determine the value of a life, using such illusions as age, or poverty?
Ordering too many tests is a worn out tome.
What criteria do you use to order tests?
What does the patients’ age or ability to have the test paid for have to do with providing treatment?
Seems to be a lot of discussion, what are the AMA standards? What government standards?
Who should set the “standard”, why allow the tort courts?
The bad medicine that gets to a tort court is mostly really bad medicine, as there are predecessor processes to get past and go into a jury trail that weed out the borderling negligences.
US society is far more neglectful than the standards set by other “first world” nations.
Hmmmm….so you think that private insurers do a better job than Medicare? I suppose you do since they cut costs by dumping people, choosing those they will insure, etc, etc. After all they need to pay the very big salaries of their executives, etc., etc. There really isn’t much point debating with you since you suffer from most of the mental blinders of the duped reactionaries. Sad.
I am not familiar with the system in, say, Japan or some countries of Europe, but it would appear that they get better results at a lower cost. I presume this is by monitoring testing, and also empowering doctors to NOT do things just because the patient has seen an ad suggesting them. I think drug ads are an evil since their intent is not to improve health but to improve drug company profits by selling more drugs whether they are really necessary or not. I know doctors who are annoyed and beset by patients who come in demanding a drug they say advertised on TV and the doctor feels pressured to prescribe it. Unnecessary but profitable for the drug company.
I think the right solution is to put in a strong regulatory system re banks and make it permanent. The problem here is that “conservatives” are knee jerk against regulation in general and government regulation in particular. They don’t seem to understand that the lack of such is one of the prime reasons for our economic problems. When “free marketers” removed bank regulation and encouraged gambling with bank assets they set the stage for the financial disaster that followed.
MM, FYI, I have both. I am on Medicare and have health insurance. You can have my Medicare. If I had the option I would give it up.
What good is Medicare if you can not find a Dr/hospital that takes it? Even in the country ther are fewer Drs who will accept new patients on Medicare. Thank heavens I do not have to test Medicaid, yet.
You have been fed a line that demonizes the major payers in this argument, and you are just repeating the punch lines.
Our present system allows things like the case in the recent past of a brain dead woman being kept alive for years(?) because some relatives simply “wanted it”. Those expenses simply cut into what could be devoted to genuine medical needs for people who were not brain dead. Since one lives with others in society, what one gets needs to be put into the context of what others need too, since resources are not infinite.
I have Medicare and I have an AARP supplemental plan. I am near a Mayo facility and they accept both. I pay very little really as a result for my first rate treatment. I don’t use Mayo’s primary care centers (that are not the core of Mayo’s services). I have never had Medicare rejected anywhere. Some places want supplemental insurance to cover what Medicare does not. But Medicare is the core of insurance for those who have it. Your experience seems very very odd.
MM said: “ Your experience seems very very odd.” The current survey is that >1/4 (73%) of Drs do not take Medicare and that number is rising. The number of hospitals that refuse it also is rising. You really should have read the article.
Prior surveys of Drs have shown that as many as 45% of them will retire if the bill is passed. But, you keep your head in the sand, and continue to think everything will be better under reformed healthcare.
“Indeed, abuse of trust and perversions of funds pervade all interests, and there seems no doubt that we have become deathly ill with affluenza, that painful, contagious, socially transmitted condition of overload, debt, anxiety and waste resulting from the dogged pursuit of more. The real question driving this whole health care debate is just a surrogate for the question that fuels our larger culture war. Where does the influence of money stop and the influence of human decency begin?”
I recommend the entire piece and possibly more on the “social contract” as professed by the “framers”.
CoRev– You write, “I believe govt is not efficient…” Do you know that govt is not efficient or do you believe it isn’t efficient? There is not much evidence that the federal government fails to deliver on its Social Security and Medicare obligations. In fact, if anything, both SSA and Medicare are models of economy and efficiency. If what you’re using here is an a priori assumption, go back and look at the facts.
SSA operates on about 2% of payroll tax. Private insurance, especially health insurance, well, kinda sorta a lot more, to the tune of up to 20% admin expenses. SSA has never, ever failed to send out its 50M or so checks each and every month for the last oh, 75 years or so. Private health insurance can barely bring itself to pay benefits due in any high cost treatment program. As between the two, which would you rather have? Privatized retirement benefits or good old Social Security, which you must have or you wouldn’t be eligible for Medicare.
And, don’t forget the Medicare Advantage programs were designed to pay out more in Trust fund money than regular Medicare in an attempt to persuade more enrollees to sign up for these private plans, thus bankrupting the Trust Fund. Didn’t work, though, since approx. 60% of enrollees remained in traditional Medicare. If it’s so awful, surely this would not have occurred.
But, relax, CoRev. No need to fash yourself. Pay cash if you want to. And, just don’t file for your insurance benefits. Problem solved! You see, where there’s a will, there’s a way. You can let the rest of us go with the new program. I, for one, will welcome any system in which medical treatment is less a means gain profit than a means to heal the sick.
What’s wrong with rich and super-rich people paying more than the middle class? Let’s see–top rate, is something like 36%, right? So, I pay 36 percent with few deductions and so does the Donald who’s got gobs of corporate tax breaks? Is that supposed to make me feel good, paying more in proportion to my disposable income than a billionaire? Gee, I wonder what Jefferson would say. He hated taxes too, but then that didn’t keep him from adding rooms to Monticello when houses were taxed by the room. Guess he thought it was worth it.
I personally didn’t think much of Pink Floyd. Didn’t then, don’t now. But, I certainly find it odd that people who prize wealth so highly think nothing of requiring other people to pay more in taxes proportionally than they do. Whatever happened to “noblesse oblige”? When Carnegie, Vanderbilt, and Rockefeller supported (yes they did!) inheritance and income taxes they did so expressly knowing that they should pay taxes to prevent people from seeking remedies to inequity in society through revolution.
I don’t know so I would need to see more data on the issue. There are a lot of trade offs at work here. A 92 year-year-old can expect to live just under 5 more years according to the 2004 overall U.S. life table. It seems the CABG procedure when appropriate could both increase the quality of those remaining 5 years and/or extend the patients life at the higher risk of the patient not surviving the procedure or having adverse events leaving him worse off then without the procedure. My preference would be to let the individual decide but now you have the issue of at 92 is the person competent to make the decsion or not. However, if you have a clear headed patient capable of considering the risks and if the medical profession shows that a successful procedure could improve the quality of the persons life then I think you do it.
CoRev knows first hand how inefficient the federal government is.
He is a retired federal civil servant, spent his career running contracts with private industry to spread the inefficiency and unearned profits to congress’ bagmen.
The scions of the inefficiency have the federal employees health benefit plan (FEHB) for life!
It is a model for an insurance cooperative where all the federal agencies pooled their employer benefits to keep the insurance industry in partial check.
Unfortuantely, there is nothing so good for the 98% of Americans not working for the ineffectives.
I am also a retired fed and I know that the refinement of incompetence and corruption has reached a high art in the discretionary side of the federal waste machine.
CoRev paints entitlements with the same brush as the pillagers he worked with.
There are 2 questions here, the first is should the 92 year old get the bypass, and the second is should society pay for it? If the 92 year old can afford the bypass with his own money the answer is clearly yes, but the second question is one that is much harder. (Remember that Insurance is the rest of us paying for the proceedure). Its a hard question, but the data of survival rates of 85+ people with bypasses is not provided. If their survival rate is no better than the rest of the 85+ population, then the answer has to be no. We have to confront the fact that we will all die. The proposal to have people discuss their desires with physicians and the reaction showed a desire to avoid facing these facts. (Actually this discussion should occur in the early 20s, since people do have car accidents etc ) If Terry Shaivo had had this discussion that whole episode of the lawyer full employment act could have been avoided.
Ilsm, you are now making an ethical argument, and one in which I support. I am not speaking for Mayo here, but I support a single payor initiative. Specifically, I support the Zeke Emanuel/Victor Fuchs plan, but the system right now is geared towards incentivizing testing and procedures.
Here’s an example. Let’s say I am in the ED, and we have two 85 year old patients walk in.
One, has increasing dementia, a cough, a headache, and lethargy. The other has a complex, deep laceration.
The laceration could be repaired by a nurse, or myself as a PA, the other patient is going to require quite a bit of thought, and possibly consultation.
Guess which one pays more….like substantially more. That’s right, the laceration.
You want to make this an ethical, austere argument…that’s fine. But, it’s the nuts and bolts that matter.
Nancy, I will not repeat my comparison of the Fed and public sector accounting differences to explain the apples to elephants comparison. The components of their overhead costs are in few ways similar! This bill actually appears to make the healthcare delivery system less efficient. Moreover, after implementing the current version(s) of the bill may actually cost the elderly, some of our poorest, more and make it less availabe to them. Remember the message of the original article?
When you bring up the Fed programs for efficiencies you conveniently ignored a minor fact that Medicare is near bankruptcy. And, if you read Michael’s comments should realize that they are severally underpaying just to extend that failing status.
There are some private Vs public entities to compare efficiencies. Let’s compare the US Postal Service to send packages compared to Fedex or UPS. Or we can compare ILSM’s favorite the military, especially their buying practices. Do I need to remind you of the hammer or toilet seat anecdote?
I am trying to discover where the Healthcare bill will provide the bulk of the promises that started it. Where are the savings? Nearly every study on the most current versions tells us insurance costs are going up. For the average family the highest annual cost is their insurance costs.
Correct. They do. A little more background on me for those that don’t know me here. I am a practicing PA at Mayo Clinic, and also function as a healthcare policy analyst/advocate. I am currently completing my doctoral degree, and am also heavily involved in healthcare policy/workforce research.
As far as your question, the UK uses the NICE system to develop a rationing of sorts. I always laugh hysterically when someone tries to use rationing as a reason to not do health reform. As if we don’t ration now….psst…we do. NOW, we ration financially, and we have insurance executives approving or disapproving procedures and treatments based on the almighty dollar. Perhaps there is a better way to do it.
ILSM, the fallacy in the demonizing of Insurance providers is that is fails to compare them against the acuality of Medicare. They too fail to pay for some patient services (not different than dropping them), and they seriously underpay for some (if not many) of those medical services paid by insurance companies. But the REAL PROBLEM/TRAVESTY, is that many of the Insurance Co payments are based upon those limits set by the underpaying Medicare.
You are of course aware that the Nazi’s program was derived from a combination of the Rockefeller plan, the Teddy Roosevelt plan, and some of FDR’s ideas as well. You do know that correct?
Just wanted to make sure you knew that it was Teddy Roosevelt, the great republican president who first tried to create a universal health plan here.
Michael, those are great examples. I’m not sure they confirm your quality care payment recommendation, but do show the “payment structure” problems inherent in our system. A problem I percieve to be exacerbated by the current reform effort. There appears to be a discerable antipathy to the elderly.
What folks are missing is that bell shaped curve that is our health may see that same antipaty translated to the very young, that other high cost population.
From what you say, Medicare sets the standards for medicine in the US.
Why did you pay in to medicare from your GS pay starting in the 1980’s?
I would like your answer, as it follows that medicare runs health care inthe US.
If that is the case the “health” insurance industry is an expensive side line for bouique medicine and nothing like something that provides a service to its buyers.
Teddy Roosevelt was a great progressive. Republicans in his day were moral and vastly different than today.
The TR republicans were involved in building not pillaging.
As to Hitler, the Nazis were too busy building a war machine, which required a healthy populace to allow doctors to pillage the German people.
The US today has no enemies, has a war profit machine, and does not needs healthy citizen, they are expendanble and it imports all the cheap labor needed; war has gone to war profiteers who build trash rather than soldiers.
USPS vs fedex/UPS; interesting both categories sell to individual persons, and also to governments, but the transport industry is much more than the “post” which started when the transport industry was not interested in carry individual letters and personal packages.
UPS evolved from a transport company to a competitor for postal services. So, I won’t go to efficiencies or inefficiencies there.
As to the warfare state, that is one buyer, acquiring for congress, from multiple sellers all of whom hold rights to charge rents (many in plants free of rent which were arsenals before war became profitable) based on their congressman buyers.
The warfare state is no reason to say medicare is not working, it is different medicare bagmen have no power compared to boutique insurance industry or war profiteer bagmen.
If the bagmen could make money providing health care humane outcomes it would be happening.
Nancy, I disagree that the social security is a good example of an efficient government program. Social security primarily provides benefits for: Retirement, Survivors, and disability. An efficient system would provide the most amount of monetary benefit for the least amount of taxes raised. However, a significant portion of the taxes we pay for social security are diverted to the general fund and spent on items not related to social security. Thus, we could stop diverting money to the general fund and either pay less in taxes and provide the same benefits or keep taxes constant and pay out more to the current beneficiaries. The diversion of funds is a source of inefficiency since we can’t be getting the most benefit for the buck when so many of the bucks are herded away from paying for retirement, survivors, and disability.
This statement: “Remember that Insurance is the rest of us paying for the proceedure” only appies to medicare, which is the only insurance that is not a premium based one sided limited term contract.
Commercial medical insurance is a bet (like at Las Vegas) between you the subscriber (in bookie terms the mark) and the insurance company against a certain contract (legalese for a wager) for a period of time to be renewed at the will of the insurance company and your emplyer.
On the other hand medicare does have some longer term contract features, and does pay for a significant part of the medicine delivered in the US.
Nothing from insurance betting parlors involved your security or welfare
What is more fun to consider than “health” insurance is death insurance where you bet the insurance company that you are going to die in the term of the wager.
I have concluded that there is no use in buying insurance.
ILSM, I didn’t say medicare set the standards. I did say they set the payment limits and to a lesser extent those services covered. Not all Insurance Cos necessarliy follow them, but many if not most do.
I paid into medicare because I had no option.
AS to medicare running healthcare in the US, as I said above that is nto neceassarily true, but it does have a huge influence. Does that mean we can blame the Fed Govt for the condition of today’s healthcare? Maybe. I think a case could be made that Medicare’s limited payments and defensive medicine may influence the rates of price increases. Both are Fed/State Govt decisions.
I do not know what the boutique statement means. You may have taken your thinking a step too far.
ilsm, that argument works in reference to straight for profit insurance. But historically most insurance was provided on a mutual basis where the reserves were invested and the profits used to subsidize payouts.
For a brief time in the late eighties the Univ of California Pension Plan actually self-funded, ROI was such that neither the University or the employees had to contribute. I don’t know how long that lasted but it was a nice run. Until 2000 John Hancock was a mutual insurance company and as a result managed a huge portfolio of forest lands in the Pacific Northwest which I would think was pretty damn profitable in past decades.
The massive increase in premiums and the deliberate change in focus from risk management to risk avoidance in recent decades is I suspect a clear result of the change of fiduciary responsibility from policy holders in a mutual company to outside stockholders in the post-Glass-Steagal world. For all the damage the Bushies did over the last nine years, they wouldn’t have had a door open if not for the Rubinistas who agreed to all this in 1996-1999.
Luckily today the adults—-. Oh shit. IT’S THE SAME GUYS.
The problem is not the insurance model itself. For that matter not all gambling is crooked, it all depends on who is running the race track/bookie shop.
You should have studied why you had to send 1.75% to Medicare.
FEHB recipients never “needed” medicare, and for the first 20 years were not “coverd” by medicare.
Then the insurance cabal figured it out. They could dump the end of lifers among the FEHB crowd into medicare.
Cherry picking at it strategic best. Thanks to Reagan.
Medicare funds so much of the “health infrastructure” covering end of lifers with facilities and equipment that would not exist, for younger people to use were it not for medicare.
Medicare makes all the munificent benefactors of hospitals look like mites……….
Medicine is funded by those folk paying the bills and while medicare may be rstrictive it is paying a huge part of the bills and makes infrastructure (indivisible public goods) available to the winning bettors or “beneficiaries” of the boutique insurances.
BTW I am retired in both CSRS and military reserve.
Which Medicare has as one of its future changes and initiatives:
“Medicare needs to change it’s payment structure from one that is focused on paying for procedural medicine, to reimbursing more for cognitive medicine, which is what primary care consists of. ”
Not sure if you have read much of Healthbeat with Maggie Mahar.
I believe you are reaching for the extremes to make your point and is not demonstrative of the true cause of rising healthcare and healthcare insurance costs. You are using age driven disorders or illnesses to drive home the point of innovation or tests, devices, and pharmaceutical with low benefit as compared to cost as the cause of healthcare and healthcare insurance cost increases. It is the later that is the major driver of rising healthcare and healthcare costs as compared to aging. Your hypothetical 92 year old is the same analogy as Reagan’s Welfare Queen driving around in the Pink Cadillac.
In the U.K. they start life with around a two year advantage in life expectancy than in the United States. By age 65 we’re are about tied; by 75 we’ve pulled a head and remain their for the the older ages. Do you think the first narrowing and then our pulling ahead in life expectancy could reflect that the NICE system does not value life for the elderly as much as we do?
Cantie, I do wish you would not bring up some of those embarrassing issues. I find it interesting that in past discusssion we have had some of these same commenters bewailing the costs the elderly demand of the current health system. Then, when we hear someone mention “death panels” they go all GaGa that it’s just not possible. Even though Michael admits and was actually advocating similar actions.
if you don’t worry your pretty little head about numbers and facts.
Nancy said something that I felt was incorrect which motivated me to provide a definition for efficiency and explain why I think the social security system does not meet the definition.
Is an ad hominem your best or only argument. You and Bruce act as if you own the social security issue. You don’t.
But you are paying for the insurance if provided thru a company in either lower wages if you are the insured or higher prices if you buy the companies products. Most large companies don’t bet with the insurance companies but self insure using the insurance company as a paying agent much as medicare does. Note that if the insurer pays those who have insurance with the company in the end will pay more as its claims rise its premiums rise. Note that the cited examples were medicare examples to boot. As Obama has observed it is not clear if society should have payed for a hip replacment for his Grandmother who had cancer elsewhere (She died before the replacement took place). Interestingly Wall Street was very big on insurance, after all what is a CDS but insurance?
The “house” always wins, the health care legislation threatens the odds for the insurance companies’ gaming tables.
Almost no company self insures, including the federal employees. The bet takers are almost always insurers making money on charging a large margin over their pay outs.
The large cost of keeping the Auto Workers union betting on health kept GM out of bankruptcy. Not.
Self insuring is not very common these days.
Insurance of any sort including property and casualty is a huge government supported often mandated rip off.
CDS’s indeed were underwritten e post facto (I thought e post facto was prohibited in the US constitution) by you and me.
Ripped off to create industries that take money and give nothing but imaginary well being.
almost 30% of a person’s medicare dollars are spent in the last YEAR of life. My question is, do we need to?
Part of the rapidly escalating rate of healthcare expenditures, is the fact that we are now treating older, and older people secondary to a perverse reimbursement structure.
Again, over the past ten years, annually, only 5% of the population accounts for almost 50% of the healthcare spending (47%). And only 1% of our population, accounts for close to 30% of healthcare spending.
So, it’s not as extreme as you think. I see patients almost daily, that should be in hospice care, and being cared for conservatively, and yet, they have this persistent family screaming “DO everything….”. We need to also examine, and discuss the cultural problems that are inherent within our approach to the medical system.
Yes it does, and I know Maggie. The problem is whether or not the proposed changes will actually happen.
The SGR was supposed to happen too. Now it looks like it might be scrapped with HR3961, Medicare was going to keep costs down with DRG’s 20 years ago too…..so call me a skeptic.
Lastly, the bulk of money, and lobbying power resides not with primary care, but with the physician specialty organizations which will fight TOOTH and NAIL against any reimbursement re-allocation.
Recently, when there was talk of cutting reimbursements to specialists like cardiology in order to increase payments to primary care, one of the leaders in the American College of Cardiology said something along the lines of “If they do this, as it is proposed, then cardiologists across the country will simply stop seeing Medicare patients altogether. Those we do see, will not receive full workups.”
SO Medicare SAYING they are going to do it, and Medicare actually DOING it, are two different things completely.
Yes, but to some degree, IF society is paying for the costs of one’s healthcare through a tax, or fee, then society itself has some say in how the money is spent. This is the part that progressives in the US have never quite grasped. If we move to a single payor system, there has to be a system of rationing as well. It has to exist. The UK has decided that there is a cost/benefit ratio to society, and certain things are not paid for, as the benefit is too low.
There are two absolutes that people in the US need to get accustomed to:
1) There is a limited amount of money, or funding. If we want to increase payments to primary care, then we have to DECREASE payments to someone else. Unless the treasury wants to continue to print money for healthcare purposes, and completely devalue the dollar.
2) There is a limited amount of healthcare resources. Not every hospital has a neurosurgeon or cardiothoracic surgeon. Not every hospital has an MRI. Not every physicians office even has a physician. Non physician providers, such as PA’s and NP’s are helping to augment the situation, but there is still limited access to the system.
When you examine it in this light, then rationing is not only inevitable, it is an absolute, the only question is how?
Should the 65 year old in stage IV adenocarcinoma of the lung get expensive experimental treatments, or should the pregnant teen who is pre-eclamptic and has no insurance be getting the state of the art treatments? These are the sorts of choices that while rare, do happen.
Corev, not sure where you’re thinking that they’re going to come from, but there is no surplus of physicians soon. Part of my current research work, is focusing on determining the optimal staffing of non physician and physician providers in primary care clinics to augment staffing needs.
Current projections by my colleague Salsberg at the AAMC, predict a shortage of 124,000 physicians by 2025. While there has been a recent 30% increase in medical school enrollment, the AAMC even admits that this will likely only temper this shortage, and not even come close to eliminating it.
this is also why the AAMC, is helping to fund expanded PA school enrollment as well.
What is more amazing than the amount of money Americans pay for Grandma’s “last year on earth” is the amount of US borrowed money spent killing individual terr’ists, and the innocents in the immediate area, with no contribution to anything. Aside from war profits and fodder for violent action movies.
Why worry about how much it cost to keep Grandma alive another year when there is no money too much to pay to kill a few disconnected terrists?
The US is utterly out of whack. Vis’a Vis Japan or Eurpoe where there are limits to what they spend for perpetual war, succor for miliarism, war mongers and war profiteers.
Michael, and now we have another abomination of a healthcare bill which provides precious little of the promises that started the effort.
Scrap it and start over. Do the things that reduce costs and improve care. A bipartisan approach can salvage the Dem elections for 2010. Continuing on the current political path will destroy the Dems for the foreseeable future. The Dem leaderrship think this bill will build a constituency, but it will destroy them before any constituency can be built. 3-4 years of higher taxes before any significant benefits are achieved is political stupidity. Thinking average American voters can not recognize it is even worse.
the supply of money is not limited, or the GDP wouldn’t go up every year.
the projected costs of medicare will go up as a percent of wages, but in absolute amount will rise far less than the absolute rise in wages. it’s not a question of not being able to afford health care, it’s a question of choosing between health care and a second trip to Vegas every year.
there are probably some treatments that have zero value, and are actually a cruel way to prolong the process of dying. but let’s not pretend that any of us would turn down a million dollar treatment that gave us six months more “quality time.”
it may be a decision we will have to face. and it could become a question of the rich getting it and the poor not getting it. but we are not there yet. so “we” can stop pretending.
Dale we are both of an age where we have probably seen the same thing. That is that we ususally die when we recognize it is time and we have given up. Many old just stop drinking and eating, and thus pass away. It seldom has anything to do with wealth.
What wealth does provide is a level of comfort for those who are disabled. Nursing home and other extended care facitlities are where those costs usually show up.
How many here want their elderly parents/grand parents to live in substandard care facilities? Maybe you prefer Michael’s no care alternative?
Nice attempt to twist my words, but I NEVER said NO CARE. I said that there are conservative treatment alternatives. How about pain management, and conservative management with medications.
I hope you are including in your dissertation research, decade old technology in imagery sharing, data transport, data mining and intelligent computing to make diagnoses more efficient.
The same was tried by attorneys (as one big litigator told me) and it came down to a take it or leave it mentality as proposed by the companies. I have no doubt cariologists believe they should be able to demand what they want to line their pockets for excess and overly costly procedures and an over abundance of procedures which you have railed against. I paid three times for a cardiogram, once to the doctor for his service at a U of M clinic, once to the hospital for the machine that probably was several years old and written off (I would love to see which account that money resides in for that particular sunk cost asset), and then again for an office visit.
If you hop into the “wabac machine” and we go back to Reagan’s term, the same was implied by the air controllers and they were fired. Granted they were under government laws against striking; but, the same philosphy applies. This is a critical function to the nation and they can try it once; lets see if the nation has the balls to take them to task.
The sentiment you expressed about Medicare doing it or not is covered in the Manager’s Amendment and will be required by them to do so. It has has parts covering cost and primary care doctors. It is not going to be that easy for Medicare to walk away from not doing it. Your doubts about doing it certainly feed the flames of apathy.
First the idea that most doctors are not going to accept Medicare seems silly to me since Medicare pays most doctors for what they do. How many doctors could survive if all patients had to pay themselves? Or could only use private insurance? I have had insurance that my MDs did not like. It was called Blue Cross. I therefore dumped Blue Cross and used AARP insurance to supplement Medicare that my doctors find very acceptable.
How does one predict the last year of life and is it more likely my last year of life will be 47, 85 or 95? I am way older than 47 but that seems to be a popular time for heart disiease to kick in.
Here is my issue: we should not imply that last year of life expenses, small, moderate or huge, are incurred only in the elderly, cancer hits a broader age distribution as well as heart disease incidents.
You sound like a researcher in a PhD program, so I suspect you are doing some hypothesis testing on your theses.
If so you have done some alpha and beta.
“almost 30% of a person’s medicare dollars are spent in the last YEAR of life.”
Just what is that 30% statistic?
Is the 30% incidence the mean incidence, the median incident or some other descriptive statistic?
What is the shape of this distribution, is it skewed.
What is the .05% value and .95% value?
And what is the age distribution of last year of life? Is it segmented in 5 or 10 year increments?
We have certainly see bipartisan approaches to date of consistently “no” votes. How much longer must we wait for the Repub Healthcare Bill or is it “status quo” and another trillion or two on top of the $2.6 trillion being paid to date? Repubs do not want bipartisan bills, they want complete control which they have had in Congress any number of times and in the presidency more so than the Dems since Carter.
There are sufficient measures in the present healthcare bill and amendment legislating improvements. It remains to be seen whether the healthcare industry, healthcare insurance, and the medical industry and its “guild” wish to participate.
As my friend “Betty the Crow” has said, the problem with today spinners of reality is such that it becomes an exercise in debunking rather than getting the true out there.
“What the people who manipulate the people, like (your name here), do is constantly create new myths for their followers to entertain (or to entertain their followers, or both). By the time the reality-based community catches up with the last one, they’re on to a new one. And they keep piling up. Someone like (your name here) never abandons the last one; he just piles the new one on top, no matter if it contradicts the last one, and becomes ever more frightened and enraged and incoherent, and there’s no way to get through to him.
For people who recognize the bullshit as what it is, keeping track of it and debunking it is so exhausting, because there’s so much of it, that the tendency is to just let it go and save the energy for trying to accomplish something positive. Who wants to spend all day mucking out the stables of (name) “brain?”
You, jimmi, cantab, sammy, just keep spinning these fairy tales with little to support them and little more than an investment in scatology to muck up what is being said and deviate from the theme, reality, or fact. As cantab has proven with his answers to Cactus, there is really no true ground with you guys. spin, spin, spin
I do not believe you can say it as you said it in terms of population percenatges. The Department of Health did a rather nice study in 2002 which breaks down those costs. Again what you are stating here is a generality when in it reality it is a much smaller percentage. Furthermore I beleive you have to break it down even father than just the elderly.
I am going to guess here and say your 5% stat is within each age group and the percenatge of that 5% for each group is shown here: http://www.ahrq.gov/research/ria19/expriach2.htm Your explanation alludes to it being only within the elderly. If you notice it does drops off rather dramatically after 79. Amongst the 5 percenters, the group between 65-79 years of age.
Rather than recite, I will C&P:
“The elderly (age 65 and over) made up around 13 percent of the U.S. population in 2002, but they consumed 36 percent of total U.S. personal health care expenses. The average health care expense in 2002 was $11,089 per year for elderly people but only $3,352 per year for working-age people (ages 19-64). Similar differences among age groups are reflected in the data on the top 5 percent of health care spenders. People 65-79 (9 percent of the total population) represented 29 percent of the top 5 percent of spenders. Similarly, people 80 years and older (about 3 percent of the population) accounted for 14 percent of the top 5 percent of spenders (see chart). However, within age groups, spending is less concentrated among those age 65 and over than for the under-65 population. The top 5 percent of elderly spenders accounted for 34 percent of all expenses by the elderly in 2002, while the top 5 percent of non-elderly spenders accounted for 49 percent of expenses by the non-elderly.” http://www.ahrq.gov/research/ria19/expendria.htm#diff1
It is a little different than how you stated it and when examined, we can begin to ask the why about the high percentage of cost consumed by a smaller percenatge of the population within each age group and overall. This isn’t a critique of you by-the-way, I apologize if it appears as such.
The study also stated: “In 2002, the top 5 percent of the population accounted for 49 percent of health care expenditures.” This particular citation (from the same study) would fit more closely with what you are saying. Your bringing this in on a discussion of the elderly somewhat blurs the issue. However, it is good to understand “why” such a small percentage of the total population across all age groups would have such a high percentage of the healthcare cost.
These 5 top-10 disorders or illnesses amounted to ~$63 billion in 1996 which is a little higher than the cost of malpractice lawsuits today; but, when they are compared to the cost of healthcare in 1994 (when Clinton attempted to pass healthcare reform) this is almost 10% of the cost of healthcare (~$600 billion) in 1996. When the other illnesses are added into the premise, the cost swells to $270 billion in 1996 or 49% of the total cost (I am being sloppy with percentages).
Furthermore, spending on one chronic condition is subtantially higher (study says twice as much for one) than on those with no chronic conditions and if all of the top 5 chronic conditions are present, than the cost expands exponentially (14 times). A greater percentage of the elderly have more chronic conditions, and > than 1, than the non-elderly. in 1996 25% of the total population had one or more chronic conditions. Just think of what this means for the children and the poor of today raised or sustaining themselves on cheap fatty and sugar ladened fast food in the future and the imact on healthcare costs. We expend people to raise themselves up by the boot straps and we want our freedom to east “shit” without any thought to the consquence of our actions or societal beliefs.
But “why,” why are these 5 chronic disorders prevalent? another study looking at 1987 to 2000 found these five disorders accounting for 31% of the total cost of healthcare.
One conclusion reached was the number of people being treated for the top 15 chronic conditions. Why?
– “The continued rise in the share of privately insured adults classified as obese.
– Changes in clinical treatment guidelines and standards for treating patients without symptoms or with mild symptoms only.
– The availability of new medical technologies to diagnose and treat patients.”
I am off on a tangent and I will conclude with this C&P:
“From 1987 to 2002, the proportion of the population treated increased 64 percent for diabetes (accounting for 80 percent of the increase in costs) and increased 500 percent for hyperlipidemia (accounting for almost 90 percent of the increase in costs). A number of factors might explain the substantial increase in treatment rates for conditions linked to obesity. These factors include a rise in the number of people with obesity-related conditions, a rise in the number of more seriously ill patients, a greater emphasis on preventive care, and the introduction of broader treatment options.”
You again are ignoring the cost/benefit ratio for a treatment which in some cases is extremely loss for some of the treatments, pharmas, and devices. Given there is not (to my knowledge) a 90 or 95% of success for a particular treatment or pharma’ it would appear that some percenatge of result is acceptable and some is not when cost is taken into account. In such comps, coberly’s statement has merit.
As I pointed out before, the medical industry has not been held to any cost/benefit ratio for the devices, pharma, or practices it has put into use as it has always enjoyed an open pocket book.
You also raised the issue of “who decides on treatment” when siblings demand addition treatment? If the patient is mentally competent, the patient decides what treatment they warrant. Doctors first have to follow the patient’s requests legally, documentation secondarily, and a guardian’s wishes in the third. I do not believe progressives have such a hard time understanding that scenario.
The issue today is the inflation of medical cost as compared to the treatment received and the practice utilized. This is the limitation on doctors as the cost of healthcare is exceeding the growth in the economy. Coberly’s premise has roughly stated this.
I think its a bad judgement call since even though he clearly stated his opinions are his own by name dropping this famous institution he’s using it to enhance his credibility and by doing so is representing this institution without its permission.
I think its a bad judgement call since even though he clearly stated his opinions are his own by name dropping this famous institution he’s using it to enhance his credibility and by doing so is representing this institution without its permission.
$690B US Government 2009 outlays for National Defense (Mini Truth code for Haliburton bottomline): Not including incidentals like the undecalred wars of error and occupation. Most of this borrowed!
$680B Social Security Outlays 2009:
$431B Medicare 2009 outlays:
Mayo don’t need a chunk of medicare, it should be selling slugs and thugs to the pentagon.
MM, without the benefit of this marvelous bill 27% of Drs already choose not to accept Medicare. An even higher (much) percentage of Drs do not accept Medicaid. You really should read the article.
Well, that is not my dissertation research, which is a comparative effectiveness evaluation of providers. But I also sit on my departmental IT committee. Mayo, I can assure you, is QUITE up to date on technology. Another paper I am writing is on the use of “Computerized Clinical Decision Support Systems; Primary Care Workforce Implications”. There is much technology can contribute, but a lot of it is still in development.
Cantab, that is not correct. I believe in several posts, I stated where I was re-iterating our Health Policy Center’s position, and where I was speaking for myself. This thread began with some bashing of the Mayo Clinic, and I was responding to these specific criticisms. In most other instances, I am speaking for myself, and not Mayo.
Run, There are several treatments with a 90+ percentage success rate. Total knee and hip arthroplasties come to mind. These remain some of the most successful surgeries done, with over 90% success at 10 years postop. Yet, reimbursement is not stellar, and spine surgeries with a much lower rate of success, are reimbursed better. This is but one example.
Secondly, while in theory, we are supposed to follow documentation secondarily, this not commonly followed. The reason being, as one physician during my training back in Ohio alluded to, was that “Dead people don’t sue”. If we have a family speaking contrarily to the documented wishes, it creates a very difficult situation. Which is why counseling of the family by the patient PRIOR to any hospitalizations is SO important.
Run, it is certainly NOT only within the elderly population, that 5% statistic is representative of the population as a whole.
As far as a change in life style? Well, I’m not going to hold my breath, but after almost 15 years in EM, I have very little faith that patients will change their behaviours. We, as a society, are too fat, eat too much cr*p, drink too much, and exercise too little.
The scariest thing to me, is the childhood obesity epidemic which is reaching scary proportions.
Ilsm, I haven’t done a post hoc on this study, but this is the one most frequently cited. Please feel free to read it. It is by Hogan, and was published in Health Affairs in 2001.
Ilsm, I haven’t done a post hoc on this study, but this is the one most frequently cited. Please feel free to read it. It is by Hogan, and was published in Health Affairs in 2001.
Run, please understand, I am supportive of the legislation as a starting point, which is really all it is. As far as increasing apathy, this is not of course my intent. My concerns over Medicare are just the result of frustration from 20 years of seeing several Medicare initiatives go nowhere. I hope that it does change now. I really, really do.
Here in reality based world, Medicare is not accepted in high cost of living areas. I have moved around a lot, use Tricare, and have found and almost 1 to 1 correlation between the cost of living and acceptance of Medicare/Tricare. In Shreveport everyone took both. But you could easily buy a 4 bedroom 3000 sq ft home on 1/3 – 1 acre for $200K. In Northern Virginia the number of Drs who would accept either was much. much lower. And none (i.e 0, nada, zilch) of the Doctors practices that were considered good-excellent (by the professionals I lived among and asked for referrals when moved in) would take Medicare/Tricare. Why? They lost money on every patience becuase the re-imbursement rate was so low. Yes you could find some single-person, speaks English as a second language practices in the not-so-nice part of town that would take them.
Some doctors would keep Medicare/Tricare patients they had but would not accept more.
Bottom line that 27% I bet are clumped in high cost of living areas and are the best doctors. And yes MM doctors can easily survive without EVER seeing a Medicare/Tricare/Medicaid patient. And more will….
Michael – Glad you understand how Old Palin, even though over-the-top, was correct about the government “death panels” coming to you.
I really have no problems with that as long as I can buy what ever I can afford even if the Governments rationing panel says they won’t pay. (Though your congress critters will be exempt as usual…)
So we are starting to get the answer to my long standing question: “What will we let poor grandma die from that rich grandma can get and live another 6 months or 6 years just becuase she can write a check?”
Seems the government rationing panels ,oops, sorry, “Optimum Care Distribution Committees” (aka “Death Panels”) will be coming to a reality based future…
We toldcha what was about to happen: “
Dec. 31 (Bloomberg) — The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.
More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.” From here: http://www.bloomberg.com/apps/news?pid=email_en&sid=aHoYSI84VdL0
You wanted him and this horrible bill. Now the seniors will pay more and more and …, and the bill hasn’t even been passed.
Those who think this will not dramatically effect the 2010 elections are living in a dream world.
For the rich, there is always succor.
A tax on them and they get no medicaid patients either.
A pox too.
CoRev said: “You wanted him and this horrible bill. Now the seniors will pay more and more and …, and the bill hasn’t even been passed”
CoRev has his conclusions and he’s sticking to them, regardless of the facts. And the facts are that the Mayo Clinic supports the HCR moving through Congress.
Mayo Clinic said (Dec 22, 2009):
http://healthpolicy.files.wordpress.com/2009/12/mayoperspectives12-22-09final.pdf
Mayo Clinic Encouraged by Senate Health Care Reform
As leaders in Washington work on the final details of the health care reform plan,
Mayo Clinic remains firmly committed to reform now more than ever. As we’ve said
before, the status quo is simply not an option.
Since its inception over three years ago, the Mayo Clinic Health Policy Center has
focused on reforming health care to improve access, quality and affordability for all
patients. This remains the lens through which we examine all proposed reform
legislation. The goal of health care reform should be to create a health care system
that provides all Americans with better care at lower cost.
Much in the Senate Manager’s Amendment is aligned with our recommendations—
including provisions to pay for value in health care, an insurance exchange, an
individual mandate, subsidies for people to achieve coverage, and pilot projects on
accountable care organizations and bundling of payments.
– Flag – Like – Edit – Moderate
The Mayo Clinic cutback affects, I believe, only one primary care place in Glendale. It does not affect pateints going to the Mayo Clinic or Hospital.
CoRev: You must either be very rich or very silly to worry so much about the welfare of the super millionaires. If you are one of them, of course you’d worry about every $100,000. But if you are not, one wonders why you find it so terrible that they might find a wee little dent in their multimillionaire incomes, etc. Odd. Perhaps you just hate poor people for some reason. Have they attacked you in some way?
And of course, one doesn’t have to use the Mayo facility in Glendale. It is not the only family medical center in the area. So odd how people so hate anything done for the poor in the USA. So many Americans seem to have abandoned all Christian virtues and taken on a kind of quais-Nazi super selfish barbarianism of attitude.
Amen and praise be to sensibility and ethics, Margery.
Clear thinking on tax equity, taxing the rich, and with “Money” from Pink Floyd playing in the bacground
http://www.youtube.com/watch?v=PDepCRY7AVc
I believe the Nazis had universal healthcare. Its also my understanding that under the Nazis the German system became more controlled by the federal government.
It’s true that the Mayo Clinic Health Policy Center is supporting healthcare reform including the Senate bill. Let’s tell the rest of the story. What did the Mayo Clinic say about the Medicare system in the same policy brief?
They stated this:
“Senate leadership made a wise decision to drop plans to expand Medicare eligibility. We also applaud the Senate for not pursuing a Medicare‐like, price controlled public option. As we’ve said, we must build health care reform upon what’s working… not on a failing Medicare system.” …”There is still much to be done. Most importantly, Congress needs to find a permanent fix to the physician payment system so that our nation’s doctors can provide full access to health care to Medicare recipients in all regions of the country. Lawmakers must move Medicare toward a system that pays for value rather than instituting across the board reductions to doctors and hospitals, which will harm the high quality, lower cost providers the most.”
Economic Predictions 2009 (aka reasons not to quit your day job)
1. Economic recovery in second quarter 2009 (defined as positive real GDP growth) (near miss)
2. Unemployment Max: July 2009, 8.7 percent (low)
3. Stock Market: December 31, 2009 — 11,500 (Dow) (high)
4. OIL (WTI 1st nearby) December 31, 2009 — $65 (low)
5. $100 billion intrastructure stimulus (2009/2010) (low)
6. Rod Blagojevich beats the rap (appoints senator) (1/2 right other undecided)
7. Britney Spears makes comeback in 2009 (Correct)
8. Yankees win 2009 world series (correct)
9. No tax hike (or cut) 2009 (correct)
10. No Israeli/Palestinean peace plan (correct)
Anyone want a rematch.
MM, super millionaires????? Most elderly are far from rich. For many Medicare is their only source of medical treatment payment, and you want to make some silly comment about super millionaires.
So you somehow don’t want Medicare expanded to more people? You didn’t want a public option that would have given Medicare like benefits to many many more. Most of your posts seem to come from the far right that basically reflects the viewpoints of the rich. If you aren’t rich, why are you so opposed to legislation that aims to help those who are not rich. You don’t want to be helped, or see others helped?
I haven’t checked it out but you imply that universal healthcare in Nazi Germany led to the Holocaust and WWII?
Universal healthcare was begun under the Weimar Republic. It simply continued under the Nazi regime. It didn’t lead to the Nazi reglime.
MM, adding more patients to a system that is failing is your solution for correcting what?
Yes, I am a conservative. I believe Govt is not efficient so more of it adds more inefficiency. Want me to enumerate the efficient parts of the Fed Govt?
I also believe that most are capable of making some contribution, but that all are responsible for their well being. For the very small portion of our population that is incapable of that contribution that provides for their well being there are already multiple programs.
So my view points do not reflect those of the rich, but those of the largest political segment of our country, the conservatives.
We need to tax the rich since they are using their extra income to destroy the advocate the destruction of the federal government and the enslavement of the poor and the middle class. The right talk about “class warfare” whenever there is talk of increasing the tax on the rich while the rich are actively pursuing “class warfare”. Taxes on the middle class go up ever year because of AMT and the increase in the “social security” limit. Taxes from the poor and middle class via income tax, social security and medicare provide the lionshare of the federal revenues for years. The rich who have most of the national assets and income have paid less and less taxes while the right are fighting to reduce their taxes to zero while increasing the tax burden on the middle class. This is why the right say Social Security and Medicare are broke without mentioning that the federal government owes the programs trillions of dollars. The right is either looking to destroy the programs or increasing the social security tax rate so that the middle class can pay an even larger portion of federal government expenses.
The Nazis had a huge militay industrial complex, the US ought to dump its version of the Kruppe tank vendors.
Public dole for the wealthy while the wealthy get to use Mayo without having to see the elderly poor.
Lovely logic.
Corruption not een since the Nazis.
Contab and CoRev broach the class warfare line when some one aside the rich seem to be developing a spine to get a share of the fruits of nature and labor.
As a Mayo Clinic Emergency Medicine Provider, and an advocate for the Mayo Clinic Health Policy Center, let me just state that we are supportive of the current HCR legislation. We are not supportive of things remaining the same. Medicare however, is flawed on so many levels. Mayo Jacksonville has already had that same policy in place. Medicare’s reimbursement structure is so flawed, especially as pertains to primary care, that many physicians no longer accept it. I remember reading a study of a major hospital in NYC, and after surveying the hospitals 90+ internal medicine physicians, they found that only 27 accepted medicare. Medicare needs to change it’s payment structure from one that is focused on paying for procedural medicine, to reimbursing more for cognitive medicine, which is what primary care consists of.
Instead of paying for quantity, and encouraging physicians to do more procedures and more tests to be paid better, the focus should be on paying for QUALITY, and paying for a physician to tell a patient “NO, you don’t need that test or operation”. Right now, it is simply too flawed to continue in it’s current form, which is primary care physicians are avoiding medicare patients.
It’s not just Mayo.
MG,
If a poor medicare patient cannot get health care that person should not enjoy the US’ nuclear umbrella either.
Delivery of medical services is not a market.
The sick mostly folks who are not trained physicians have no market power nor ability to assimilate and use information related to their “economic” decisions.
Except for the wealthy, and retired federal employees and military members with employer based medical insurance for life.
It is wrong to disregrad the needs of a sick man only because of that man’s ability to get funding for the service.
Unfortunate for Mayo to spread such swill.
If you get sick, die fast and cheap!!
What does Palin say about Mayo running a death panel?
Health care is not a market, so what does government inefficiency have to do with anything?
MH, how do we measure quality on a per visit basis? Yup, you Mr Patient are free of cancer. Thanks be to my great care! That’ll be $3,500. Submit my bill to the Govt panel.
Michael Halasy,
As a Mayo Clinic Emergency Medicine Provider, and an advocate for the Mayo Clinic Health Policy Center, let me just state that we are supportive of the current HCR legislation.
That makes sense since the current legislation today is focused on demonizing the insurance industry rather then proposing to restructure the way actual medical services are delivered and priced.
Cantab, we are supportive, this does not mean that we think the legislation is perfect. But, Congress simply cannot complete all the restructuring needed in fell swoop. The bill could certainly be improved, but it is a start.
There are many potential quality measures. We need to establish pay for value initiatives, and for those institutions who are providing quality care (outcomes measured), and doing so at a lower cost, they should be reimbursed at a higher rate. For those institutions who rank highest in costs, but whose outcomes are mediocre, or lower, well, you get the picture.
Personally, and I am not speaking for Mayo here, I am a fan of the Prometheus payment system. A sort of capitation if you will.
Michael,
I’m not at all supportive of the current legislation. I think that any new system has to put the incentives on individuals to drive down costs. Although I don’t know how to get there but we need to do even more testing and monitoring for those that want it which means we need to drive down the average costs for tests and procedures while at the same time driving down total costs for the system as a whole. Basically I want more healthcare services for much less cost. Pie in the sky? I don’t think so. Look at the fall in the price of a new computer, oil exploration, agricultural products, or the production of just about any other commodity. They all have been falling, except for the two problem products — medicine and higher education. With the development and expansion of information technology there is no good reason the prices on these products to stay up.
Cantab, I am not an economist, although I have completed a lot of undergarduate economic work. Correct me if I am wrong, but Healthcare costs have relatively low price elasticity scores, correct? Suggesting that they are relatively inelastic. Utility costs are also rising, and they are to a degree inelastic as well by my understanding. I think that you have the right idea, but the completely wrong focus. We DON’T need to do more testing and monitoring. The point is, that much of the testing, treatments, and medical care is wasteful. This was highlighted in the Dartmouth Medical Atlas, and then later in the Gawande article.
We need to provide BETTER care, not more care. Lastly, and again, this is me speaking, and NOT Mayo, but we need to move to a system of rationing.
Does an 85 year old with end stage renal disease and multiple comorbidities need dialysis?
Should a 92 year old get a coronary bypass?
We need to look societally at cost vs benefit. I simply do not see an possibility of MORE healthcare services for a lower cost. It won’t happen.
I guess it depends if you’re that 85-year-old with renal disease, or the 92-year-old with a bad heart, and you haven’t yet become a vegetable. Just because your body has aged, doesn’t mean you aren’t human any longer.
Also, since this is an open thread, wanted to post this link from the Huff Post.
http://moveyourmoney.info/
If you are fed up with the big banks, there’s a suggestion. Take it or leave it, though, your choice.
Never said that you aren’t, but how about conservative treatment? There are always alternatives, but I think that doing a CABG on a 92 year old is scandalous, and wasteful. I actually wrote an editorial about this very topic this past summer. We need to pay for physicians to provide GOOD care, and sometimes that means (gasp) not doing a surgery, or procedure, or maybe NOT doing a test. Instead, we have a system that rewards ME as a provider for ordering more, more, more.
I had this very conversation with a patient the other day, who was very concerned about her condition, and wanted a “CAT scan”. I told her that I didn’t think that it was necessary at this time, and refused to order it. I’m sure she probably went elsewhere, and got it, even thought there was really no indication clinically for it.
But the cost of the manufacturing equipment to build the computer, the cost of building a place to put it, and anything else that is not a commodity contrinue to rise.
I work in a high-tech service industry. It may yet be affected by commoditization, but do we really believe health care delivery will ever be?
Contab,
Insurance “industry” is an easy target.
Add nothing! Unless you are healthy and want to bet you will get deathly ill and collect before they dump you.
Use credit unions!
Micheal,
What due diligence does a social contract owe the old and the poor. When is a society negligent toward the helpness and needy?
What authority has a medic to determine the value of a life, using such illusions as age, or poverty?
Ordering too many tests is a worn out tome.
What criteria do you use to order tests?
What does the patients’ age or ability to have the test paid for have to do with providing treatment?
Seems to be a lot of discussion, what are the AMA standards? What government standards?
Who should set the “standard”, why allow the tort courts?
The bad medicine that gets to a tort court is mostly really bad medicine, as there are predecessor processes to get past and go into a jury trail that weed out the borderling negligences.
US society is far more neglectful than the standards set by other “first world” nations.
The US is third world in many aspects.
Hmmmm….so you think that private insurers do a better job than Medicare? I suppose you do since they cut costs by dumping people, choosing those they will insure, etc, etc. After all they need to pay the very big salaries of their executives, etc., etc. There really isn’t much point debating with you since you suffer from most of the mental blinders of the duped reactionaries. Sad.
I am not familiar with the system in, say, Japan or some countries of Europe, but it would appear that they get better results at a lower cost. I presume this is by monitoring testing, and also empowering doctors to NOT do things just because the patient has seen an ad suggesting them. I think drug ads are an evil since their intent is not to improve health but to improve drug company profits by selling more drugs whether they are really necessary or not. I know doctors who are annoyed and beset by patients who come in demanding a drug they say advertised on TV and the doctor feels pressured to prescribe it. Unnecessary but profitable for the drug company.
I think the right solution is to put in a strong regulatory system re banks and make it permanent. The problem here is that “conservatives” are knee jerk against regulation in general and government regulation in particular. They don’t seem to understand that the lack of such is one of the prime reasons for our economic problems. When “free marketers” removed bank regulation and encouraged gambling with bank assets they set the stage for the financial disaster that followed.
MM, FYI, I have both. I am on Medicare and have health insurance. You can have my Medicare. If I had the option I would give it up.
What good is Medicare if you can not find a Dr/hospital that takes it? Even in the country ther are fewer Drs who will accept new patients on Medicare. Thank heavens I do not have to test Medicaid, yet.
You have been fed a line that demonizes the major payers in this argument, and you are just repeating the punch lines.
Our present system allows things like the case in the recent past of a brain dead woman being kept alive for years(?) because some relatives simply “wanted it”. Those expenses simply cut into what could be devoted to genuine medical needs for people who were not brain dead. Since one lives with others in society, what one gets needs to be put into the context of what others need too, since resources are not infinite.
I have Medicare and I have an AARP supplemental plan. I am near a Mayo facility and they accept both. I pay very little really as a result for my first rate treatment. I don’t use Mayo’s primary care centers (that are not the core of Mayo’s services). I have never had Medicare rejected anywhere. Some places want supplemental insurance to cover what Medicare does not. But Medicare is the core of insurance for those who have it. Your experience seems very very odd.
MM said: “ Your experience seems very very odd.” The current survey is that >1/4 (73%) of Drs do not take Medicare and that number is rising. The number of hospitals that refuse it also is rising. You really should have read the article.
Prior surveys of Drs have shown that as many as 45% of them will retire if the bill is passed. But, you keep your head in the sand, and continue to think everything will be better under reformed healthcare.
At this link is a historian’s perspective on the recent health debate, a perspective considering the “founding fathers'” views on human nature.
http://greathistory.com/health-care-reform-and-our-unrequited-culture-war.htm
The last paragraph is informative:
“Indeed, abuse of trust and perversions of funds pervade all interests, and there seems no doubt that we have become deathly ill with affluenza, that painful, contagious, socially transmitted condition of overload, debt, anxiety and waste resulting from the dogged pursuit of more. The real question driving this whole health care debate is just a surrogate for the question that fuels our larger culture war. Where does the influence of money stop and the influence of human decency begin?”
I recommend the entire piece and possibly more on the “social contract” as professed by the “framers”.
CoRev– You write, “I believe govt is not efficient…” Do you know that govt is not efficient or do you believe it isn’t efficient? There is not much evidence that the federal government fails to deliver on its Social Security and Medicare obligations. In fact, if anything, both SSA and Medicare are models of economy and efficiency. If what you’re using here is an a priori assumption, go back and look at the facts.
SSA operates on about 2% of payroll tax. Private insurance, especially health insurance, well, kinda sorta a lot more, to the tune of up to 20% admin expenses. SSA has never, ever failed to send out its 50M or so checks each and every month for the last oh, 75 years or so. Private health insurance can barely bring itself to pay benefits due in any high cost treatment program. As between the two, which would you rather have? Privatized retirement benefits or good old Social Security, which you must have or you wouldn’t be eligible for Medicare.
And, don’t forget the Medicare Advantage programs were designed to pay out more in Trust fund money than regular Medicare in an attempt to persuade more enrollees to sign up for these private plans, thus bankrupting the Trust Fund. Didn’t work, though, since approx. 60% of enrollees remained in traditional Medicare. If it’s so awful, surely this would not have occurred.
But, relax, CoRev. No need to fash yourself. Pay cash if you want to. And, just don’t file for your insurance benefits. Problem solved! You see, where there’s a will, there’s a way. You can let the rest of us go with the new program. I, for one, will welcome any system in which medical treatment is less a means gain profit than a means to heal the sick.
What’s wrong with rich and super-rich people paying more than the middle class? Let’s see–top rate, is something like 36%, right? So, I pay 36 percent with few deductions and so does the Donald who’s got gobs of corporate tax breaks? Is that supposed to make me feel good, paying more in proportion to my disposable income than a billionaire? Gee, I wonder what Jefferson would say. He hated taxes too, but then that didn’t keep him from adding rooms to Monticello when houses were taxed by the room. Guess he thought it was worth it.
I personally didn’t think much of Pink Floyd. Didn’t then, don’t now. But, I certainly find it odd that people who prize wealth so highly think nothing of requiring other people to pay more in taxes proportionally than they do. Whatever happened to “noblesse oblige”? When Carnegie, Vanderbilt, and Rockefeller supported (yes they did!) inheritance and income taxes they did so expressly knowing that they should pay taxes to prevent people from seeking remedies to inequity in society through revolution.
Get the message, GOP?
Why not refute the line MM has been fed?
Michael,
Should a 92 year old get a coronary bypass?
I don’t know so I would need to see more data on the issue. There are a lot of trade offs at work here. A 92 year-year-old can expect to live just under 5 more years according to the 2004 overall U.S. life table. It seems the CABG procedure when appropriate could both increase the quality of those remaining 5 years and/or extend the patients life at the higher risk of the patient not surviving the procedure or having adverse events leaving him worse off then without the procedure. My preference would be to let the individual decide but now you have the issue of at 92 is the person competent to make the decsion or not. However, if you have a clear headed patient capable of considering the risks and if the medical profession shows that a successful procedure could improve the quality of the persons life then I think you do it.
CoRev knows first hand how inefficient the federal government is.
He is a retired federal civil servant, spent his career running contracts with private industry to spread the inefficiency and unearned profits to congress’ bagmen.
The scions of the inefficiency have the federal employees health benefit plan (FEHB) for life!
It is a model for an insurance cooperative where all the federal agencies pooled their employer benefits to keep the insurance industry in partial check.
Unfortuantely, there is nothing so good for the 98% of Americans not working for the ineffectives.
I am also a retired fed and I know that the refinement of incompetence and corruption has reached a high art in the discretionary side of the federal waste machine.
CoRev paints entitlements with the same brush as the pillagers he worked with.
There are 2 questions here, the first is should the 92 year old get the bypass, and the second is should society pay for it? If the 92 year old can afford the bypass with his own money the answer is clearly yes, but the second question is one that is much harder. (Remember that Insurance is the rest of us paying for the proceedure). Its a hard question, but the data of survival rates of 85+ people with bypasses is not provided. If their survival rate is no better than the rest of the 85+ population, then the answer has to be no. We have to confront the fact that we will all die. The proposal to have people discuss their desires with physicians and the reaction showed a desire to avoid facing these facts. (Actually this discussion should occur in the early 20s, since people do have car accidents etc ) If Terry Shaivo had had this discussion that whole episode of the lawyer full employment act could have been avoided.
Ilsm, you are now making an ethical argument, and one in which I support. I am not speaking for Mayo here, but I support a single payor initiative. Specifically, I support the Zeke Emanuel/Victor Fuchs plan, but the system right now is geared towards incentivizing testing and procedures.
Here’s an example. Let’s say I am in the ED, and we have two 85 year old patients walk in.
One, has increasing dementia, a cough, a headache, and lethargy. The other has a complex, deep laceration.
The laceration could be repaired by a nurse, or myself as a PA, the other patient is going to require quite a bit of thought, and possibly consultation.
Guess which one pays more….like substantially more. That’s right, the laceration.
You want to make this an ethical, austere argument…that’s fine. But, it’s the nuts and bolts that matter.
Nancy, I will not repeat my comparison of the Fed and public sector accounting differences to explain the apples to elephants comparison. The components of their overhead costs are in few ways similar! This bill actually appears to make the healthcare delivery system less efficient. Moreover, after implementing the current version(s) of the bill may actually cost the elderly, some of our poorest, more and make it less availabe to them. Remember the message of the original article?
When you bring up the Fed programs for efficiencies you conveniently ignored a minor fact that Medicare is near bankruptcy. And, if you read Michael’s comments should realize that they are severally underpaying just to extend that failing status.
There are some private Vs public entities to compare efficiencies. Let’s compare the US Postal Service to send packages compared to Fedex or UPS. Or we can compare ILSM’s favorite the military, especially their buying practices. Do I need to remind you of the hammer or toilet seat anecdote?
I am trying to discover where the Healthcare bill will provide the bulk of the promises that started it. Where are the savings? Nearly every study on the most current versions tells us insurance costs are going up. For the average family the highest annual cost is their insurance costs.
Correct. They do. A little more background on me for those that don’t know me here. I am a practicing PA at Mayo Clinic, and also function as a healthcare policy analyst/advocate. I am currently completing my doctoral degree, and am also heavily involved in healthcare policy/workforce research.
As far as your question, the UK uses the NICE system to develop a rationing of sorts. I always laugh hysterically when someone tries to use rationing as a reason to not do health reform. As if we don’t ration now….psst…we do. NOW, we ration financially, and we have insurance executives approving or disapproving procedures and treatments based on the almighty dollar. Perhaps there is a better way to do it.
I also agree with you on DTC advertising.
ILSM, the fallacy in the demonizing of Insurance providers is that is fails to compare them against the acuality of Medicare. They too fail to pay for some patient services (not different than dropping them), and they seriously underpay for some (if not many) of those medical services paid by insurance companies. But the REAL PROBLEM/TRAVESTY, is that many of the Insurance Co payments are based upon those limits set by the underpaying Medicare.
You are of course aware that the Nazi’s program was derived from a combination of the Rockefeller plan, the Teddy Roosevelt plan, and some of FDR’s ideas as well. You do know that correct?
Just wanted to make sure you knew that it was Teddy Roosevelt, the great republican president who first tried to create a universal health plan here.
Hitler merely adopted some american plans/ideas.
Michael, those are great examples. I’m not sure they confirm your quality care payment recommendation, but do show the “payment structure” problems inherent in our system. A problem I percieve to be exacerbated by the current reform effort. There appears to be a discerable antipathy to the elderly.
What folks are missing is that bell shaped curve that is our health may see that same antipaty translated to the very young, that other high cost population.
From what you say, Medicare sets the standards for medicine in the US.
Why did you pay in to medicare from your GS pay starting in the 1980’s?
I would like your answer, as it follows that medicare runs health care inthe US.
If that is the case the “health” insurance industry is an expensive side line for bouique medicine and nothing like something that provides a service to its buyers.
You’re thinking……………
Michael,
Teddy Roosevelt was a great progressive. Republicans in his day were moral and vastly different than today.
The TR republicans were involved in building not pillaging.
As to Hitler, the Nazis were too busy building a war machine, which required a healthy populace to allow doctors to pillage the German people.
The US today has no enemies, has a war profit machine, and does not needs healthy citizen, they are expendanble and it imports all the cheap labor needed; war has gone to war profiteers who build trash rather than soldiers.
All civilized decision are ethical.
Ethics separate man from machine, which automation is an answer to expensive doctors.
If it were all nuts and bolts I can find a programmer.
Hi Michael. I am glad you are back.
CorRev,
Grapefruit cannot be compared to grapeshot.
USPS vs fedex/UPS; interesting both categories sell to individual persons, and also to governments, but the transport industry is much more than the “post” which started when the transport industry was not interested in carry individual letters and personal packages.
UPS evolved from a transport company to a competitor for postal services. So, I won’t go to efficiencies or inefficiencies there.
As to the warfare state, that is one buyer, acquiring for congress, from multiple sellers all of whom hold rights to charge rents (many in plants free of rent which were arsenals before war became profitable) based on their congressman buyers.
The warfare state is no reason to say medicare is not working, it is different medicare bagmen have no power compared to boutique insurance industry or war profiteer bagmen.
If the bagmen could make money providing health care humane outcomes it would be happening.
Nancy,
I disagree that the social security is a good example of an efficient government program. Social security primarily provides benefits for: Retirement, Survivors, and disability. An efficient system would provide the most amount of monetary benefit for the least amount of taxes raised. However, a significant portion of the taxes we pay for social security are diverted to the general fund and spent on items not related to social security. Thus, we could stop diverting money to the general fund and either pay less in taxes and provide the same benefits or keep taxes constant and pay out more to the current beneficiaries. The diversion of funds is a source of inefficiency since we can’t be getting the most benefit for the buck when so many of the bucks are herded away from paying for retirement, survivors, and disability.
Nancy,
The GOP prefers to tax the living rather than the dead. I think that says a lot about the demographics of the GOP base.
Lyle,
This statement: “Remember that Insurance is the rest of us paying for the proceedure” only appies to medicare, which is the only insurance that is not a premium based one sided limited term contract.
Commercial medical insurance is a bet (like at Las Vegas) between you the subscriber (in bookie terms the mark) and the insurance company against a certain contract (legalese for a wager) for a period of time to be renewed at the will of the insurance company and your emplyer.
On the other hand medicare does have some longer term contract features, and does pay for a significant part of the medicine delivered in the US.
Nothing from insurance betting parlors involved your security or welfare
What is more fun to consider than “health” insurance is death insurance where you bet the insurance company that you are going to die in the term of the wager.
I have concluded that there is no use in buying insurance.
ILSM, I didn’t say medicare set the standards. I did say they set the payment limits and to a lesser extent those services covered. Not all Insurance Cos necessarliy follow them, but many if not most do.
I paid into medicare because I had no option.
AS to medicare running healthcare in the US, as I said above that is nto neceassarily true, but it does have a huge influence. Does that mean we can blame the Fed Govt for the condition of today’s healthcare? Maybe. I think a case could be made that Medicare’s limited payments and defensive medicine may influence the rates of price increases. Both are Fed/State Govt decisions.
I do not know what the boutique statement means. You may have taken your thinking a step too far.
Nice point Cantab!
co rev
the solution, i think, is government run clinics where the doctors work for a wage that medicare can afford to pay.
ilsm, that argument works in reference to straight for profit insurance. But historically most insurance was provided on a mutual basis where the reserves were invested and the profits used to subsidize payouts.
For a brief time in the late eighties the Univ of California Pension Plan actually self-funded, ROI was such that neither the University or the employees had to contribute. I don’t know how long that lasted but it was a nice run. Until 2000 John Hancock was a mutual insurance company and as a result managed a huge portfolio of forest lands in the Pacific Northwest which I would think was pretty damn profitable in past decades.
The massive increase in premiums and the deliberate change in focus from risk management to risk avoidance in recent decades is I suspect a clear result of the change of fiduciary responsibility from policy holders in a mutual company to outside stockholders in the post-Glass-Steagal world. For all the damage the Bushies did over the last nine years, they wouldn’t have had a door open if not for the Rubinistas who agreed to all this in 1996-1999.
Luckily today the adults—-. Oh shit. IT’S THE SAME GUYS.
The problem is not the insurance model itself. For that matter not all gambling is crooked, it all depends on who is running the race track/bookie shop.
Cantab
nice analysis, as Co Rev says, if you don’t worry your pretty little head about numbers and facts.
You should have studied why you had to send 1.75% to Medicare.
FEHB recipients never “needed” medicare, and for the first 20 years were not “coverd” by medicare.
Then the insurance cabal figured it out. They could dump the end of lifers among the FEHB crowd into medicare.
Cherry picking at it strategic best. Thanks to Reagan.
Medicare funds so much of the “health infrastructure” covering end of lifers with facilities and equipment that would not exist, for younger people to use were it not for medicare.
Medicare makes all the munificent benefactors of hospitals look like mites……….
Medicine is funded by those folk paying the bills and while medicare may be rstrictive it is paying a huge part of the bills and makes infrastructure (indivisible public goods) available to the winning bettors or “beneficiaries” of the boutique insurances.
BTW I am retired in both CSRS and military reserve.
ILSM, yes I know you are retired from both, and when you call out my grand FEHB benefits, understand you are actually talking also about yourself.
Dale, it might work in a few years after we build up a surplus supply of Drs.
Slugs,
Given how many of the dead vote for democrats, especially in Chicago, you would think the democrats would treat them better.
Nancy,
Get the message, GOP?
You don’t like pink Floyd because they’re neither country or western?
What’s wrong with rich and super-rich people paying more than the middle class?
It comes from a peasant’s mentality that in the long run is not good for this country.
“Whatever happened to “noblesse oblige”?
Find some noblemen in the United States and then get back to me.
Michael:
Which Medicare has as one of its future changes and initiatives:
“Medicare needs to change it’s payment structure from one that is focused on paying for procedural medicine, to reimbursing more for cognitive medicine, which is what primary care consists of. ”
Not sure if you have read much of Healthbeat with Maggie Mahar.
Michael:
I believe you are reaching for the extremes to make your point and is not demonstrative of the true cause of rising healthcare and healthcare insurance costs. You are using age driven disorders or illnesses to drive home the point of innovation or tests, devices, and pharmaceutical with low benefit as compared to cost as the cause of healthcare and healthcare insurance cost increases. It is the later that is the major driver of rising healthcare and healthcare costs as compared to aging. Your hypothetical 92 year old is the same analogy as Reagan’s Welfare Queen driving around in the Pink Cadillac.
Otherwise I am with you on the issue.
Michael:
I would add that ability to pay is the methodology for the present rationing scheme.
Michael,
In the U.K. they start life with around a two year advantage in life expectancy than in the United States. By age 65 we’re are about tied; by 75 we’ve pulled a head and remain their for the the older ages. Do you think the first narrowing and then our pulling ahead in life expectancy could reflect that the NICE system does not value life for the elderly as much as we do?
Cantie, I do wish you would not bring up some of those embarrassing issues. I find it interesting that in past discusssion we have had some of these same commenters bewailing the costs the elderly demand of the current health system. Then, when we hear someone mention “death panels” they go all GaGa that it’s just not possible. Even though Michael admits and was actually advocating similar actions.
Coberly,
if you don’t worry your pretty little head about numbers and facts.
Nancy said something that I felt was incorrect which motivated me to provide a definition for efficiency and explain why I think the social security system does not meet the definition.
Is an ad hominem your best or only argument. You and Bruce act as if you own the social security issue. You don’t.
But you are paying for the insurance if provided thru a company in either lower wages if you are the insured or higher prices if you buy the companies products. Most large companies don’t bet with the insurance companies but self insure using the insurance company as a paying agent much as medicare does. Note that if the insurer pays those who have insurance with the company in the end will pay more as its claims rise its premiums rise. Note that the cited examples were medicare examples to boot. As Obama has observed it is not clear if society should have payed for a hip replacment for his Grandmother who had cancer elsewhere (She died before the replacement took place).
Interestingly Wall Street was very big on insurance, after all what is a CDS but insurance?
Tricare is better.
Lyle,
The “house” always wins, the health care legislation threatens the odds for the insurance companies’ gaming tables.
Almost no company self insures, including the federal employees. The bet takers are almost always insurers making money on charging a large margin over their pay outs.
The large cost of keeping the Auto Workers union betting on health kept GM out of bankruptcy. Not.
Self insuring is not very common these days.
Insurance of any sort including property and casualty is a huge government supported often mandated rip off.
CDS’s indeed were underwritten e post facto (I thought e post facto was prohibited in the US constitution) by you and me.
Ripped off to create industries that take money and give nothing but imaginary well being.
Not necessarily Run.
almost 30% of a person’s medicare dollars are spent in the last YEAR of life. My question is, do we need to?
Part of the rapidly escalating rate of healthcare expenditures, is the fact that we are now treating older, and older people secondary to a perverse reimbursement structure.
Again, over the past ten years, annually, only 5% of the population accounts for almost 50% of the healthcare spending (47%). And only 1% of our population, accounts for close to 30% of healthcare spending.
So, it’s not as extreme as you think. I see patients almost daily, that should be in hospice care, and being cared for conservatively, and yet, they have this persistent family screaming “DO everything….”. We need to also examine, and discuss the cultural problems that are inherent within our approach to the medical system.
Yes it does, and I know Maggie. The problem is whether or not the proposed changes will actually happen.
The SGR was supposed to happen too. Now it looks like it might be scrapped with HR3961, Medicare was going to keep costs down with DRG’s 20 years ago too…..so call me a skeptic.
Lastly, the bulk of money, and lobbying power resides not with primary care, but with the physician specialty organizations which will fight TOOTH and NAIL against any reimbursement re-allocation.
Recently, when there was talk of cutting reimbursements to specialists like cardiology in order to increase payments to primary care, one of the leaders in the American College of Cardiology said something along the lines of “If they do this, as it is proposed, then cardiologists across the country will simply stop seeing Medicare patients altogether. Those we do see, will not receive full workups.”
SO Medicare SAYING they are going to do it, and Medicare actually DOING it, are two different things completely.
Yes, but to some degree, IF society is paying for the costs of one’s healthcare through a tax, or fee, then society itself has some say in how the money is spent. This is the part that progressives in the US have never quite grasped. If we move to a single payor system, there has to be a system of rationing as well. It has to exist. The UK has decided that there is a cost/benefit ratio to society, and certain things are not paid for, as the benefit is too low.
There are two absolutes that people in the US need to get accustomed to:
1) There is a limited amount of money, or funding. If we want to increase payments to primary care, then we have to DECREASE payments to someone else. Unless the treasury wants to continue to print money for healthcare purposes, and completely devalue the dollar.
2) There is a limited amount of healthcare resources. Not every hospital has a neurosurgeon or cardiothoracic surgeon. Not every hospital has an MRI. Not every physicians office even has a physician. Non physician providers, such as PA’s and NP’s are helping to augment the situation, but there is still limited access to the system.
When you examine it in this light, then rationing is not only inevitable, it is an absolute, the only question is how?
Should the 65 year old in stage IV adenocarcinoma of the lung get expensive experimental treatments, or should the pregnant teen who is pre-eclamptic and has no insurance be getting the state of the art treatments? These are the sorts of choices that while rare, do happen.
Corev, not sure where you’re thinking that they’re going to come from, but there is no surplus of physicians soon. Part of my current research work, is focusing on determining the optimal staffing of non physician and physician providers in primary care clinics to augment staffing needs.
Current projections by my colleague Salsberg at the AAMC, predict a shortage of 124,000 physicians by 2025. While there has been a recent 30% increase in medical school enrollment, the AAMC even admits that this will likely only temper this shortage, and not even come close to eliminating it.
this is also why the AAMC, is helping to fund expanded PA school enrollment as well.
What is more amazing than the amount of money Americans pay for Grandma’s “last year on earth” is the amount of US borrowed money spent killing individual terr’ists, and the innocents in the immediate area, with no contribution to anything. Aside from war profits and fodder for violent action movies.
Why worry about how much it cost to keep Grandma alive another year when there is no money too much to pay to kill a few disconnected terrists?
The US is utterly out of whack. Vis’a Vis Japan or Eurpoe where there are limits to what they spend for perpetual war, succor for miliarism, war mongers and war profiteers.
O Tempores O Mores!!
Should the US have limited resources for pregnant teens and an unlimited war machine?
Travel to Mars or ration health care?
The EU spends less than 1% GDP for warfare while the US spends 5% plus.
It was a series of economic decisions made against the interests of the common welfare, the other half of the preamble to the US constitution……..
Michael, and now we have another abomination of a healthcare bill which provides precious little of the promises that started the effort.
Scrap it and start over. Do the things that reduce costs and improve care. A bipartisan approach can salvage the Dem elections for 2010. Continuing on the current political path will destroy the Dems for the foreseeable future. The Dem leaderrship think this bill will build a constituency, but it will destroy them before any constituency can be built. 3-4 years of higher taxes before any significant benefits are achieved is political stupidity. Thinking average American voters can not recognize it is even worse.
Michael with each later comment you confirm the futility of this healthcare bill. A $trillion spent to make things even worse faster.
nonsense
the supply of money is not limited, or the GDP wouldn’t go up every year.
the projected costs of medicare will go up as a percent of wages, but in absolute amount will rise far less than the absolute rise in wages. it’s not a question of not being able to afford health care, it’s a question of choosing between health care and a second trip to Vegas every year.
there are probably some treatments that have zero value, and are actually a cruel way to prolong the process of dying. but let’s not pretend that any of us would turn down a million dollar treatment that gave us six months more “quality time.”
it may be a decision we will have to face. and it could become a question of the rich getting it and the poor not getting it. but we are not there yet. so “we” can stop pretending.
lyle
insurance is not “us” paying for it. it is us paying against the chance that “we” will need it.
Dale we are both of an age where we have probably seen the same thing. That is that we ususally die when we recognize it is time and we have given up. Many old just stop drinking and eating, and thus pass away. It seldom has anything to do with wealth.
What wealth does provide is a level of comfort for those who are disabled. Nursing home and other extended care facitlities are where those costs usually show up.
How many here want their elderly parents/grand parents to live in substandard care facilities? Maybe you prefer Michael’s no care alternative?
Nice attempt to twist my words, but I NEVER said NO CARE. I said that there are conservative treatment alternatives. How about pain management, and conservative management with medications.
Sometimes, less is more.
Michael,
I hope you are including in your dissertation research, decade old technology in imagery sharing, data transport, data mining and intelligent computing to make diagnoses more efficient.
However, that may not be Mayo’s business model.
Are you sure Say’s Law is defunct?
Michael:
The same was tried by attorneys (as one big litigator told me) and it came down to a take it or leave it mentality as proposed by the companies. I have no doubt cariologists believe they should be able to demand what they want to line their pockets for excess and overly costly procedures and an over abundance of procedures which you have railed against. I paid three times for a cardiogram, once to the doctor for his service at a U of M clinic, once to the hospital for the machine that probably was several years old and written off (I would love to see which account that money resides in for that particular sunk cost asset), and then again for an office visit.
If you hop into the “wabac machine” and we go back to Reagan’s term, the same was implied by the air controllers and they were fired. Granted they were under government laws against striking; but, the same philosphy applies. This is a critical function to the nation and they can try it once; lets see if the nation has the balls to take them to task.
The sentiment you expressed about Medicare doing it or not is covered in the Manager’s Amendment and will be required by them to do so. It has has parts covering cost and primary care doctors. It is not going to be that easy for Medicare to walk away from not doing it. Your doubts about doing it certainly feed the flames of apathy.
First the idea that most doctors are not going to accept Medicare seems silly to me since Medicare pays most doctors for what they do. How many doctors could survive if all patients had to pay themselves? Or could only use private insurance? I have had insurance that my MDs did not like. It was called Blue Cross. I therefore dumped Blue Cross and used AARP insurance to supplement Medicare that my doctors find very acceptable.
Michael,
I am getting a bit geeky here.
How does one predict the last year of life and is it more likely my last year of life will be 47, 85 or 95? I am way older than 47 but that seems to be a popular time for heart disiease to kick in.
Here is my issue: we should not imply that last year of life expenses, small, moderate or huge, are incurred only in the elderly, cancer hits a broader age distribution as well as heart disease incidents.
You sound like a researcher in a PhD program, so I suspect you are doing some hypothesis testing on your theses.
If so you have done some alpha and beta.
“almost 30% of a person’s medicare dollars are spent in the last YEAR of life.”
Just what is that 30% statistic?
Is the 30% incidence the mean incidence, the median incident or some other descriptive statistic?
What is the shape of this distribution, is it skewed.
What is the .05% value and .95% value?
And what is the age distribution of last year of life? Is it segmented in 5 or 10 year increments?
CoRev:
We have certainly see bipartisan approaches to date of consistently “no” votes. How much longer must we wait for the Repub Healthcare Bill or is it “status quo” and another trillion or two on top of the $2.6 trillion being paid to date? Repubs do not want bipartisan bills, they want complete control which they have had in Congress any number of times and in the presidency more so than the Dems since Carter.
There are sufficient measures in the present healthcare bill and amendment legislating improvements. It remains to be seen whether the healthcare industry, healthcare insurance, and the medical industry and its “guild” wish to participate.
As my friend “Betty the Crow” has said, the problem with today spinners of reality is such that it becomes an exercise in debunking rather than getting the true out there.
“What the people who manipulate the people, like (your name here), do is constantly create new myths for their followers to entertain (or to entertain their followers, or both). By the time the reality-based community catches up with the last one, they’re on to a new one. And they keep piling up. Someone like (your name here) never abandons the last one; he just piles the new one on top, no matter if it contradicts the last one, and becomes ever more frightened and enraged and incoherent, and there’s no way to get through to him.
For people who recognize the bullshit as what it is, keeping track of it and debunking it is so exhausting, because there’s so much of it, that the tendency is to just let it go and save the energy for trying to accomplish something positive. Who wants to spend all day mucking out the stables of (name) “brain?”
You, jimmi, cantab, sammy, just keep spinning these fairy tales with little to support them and little more than an investment in scatology to muck up what is being said and deviate from the theme, reality, or fact. As cantab has proven with his answers to Cactus, there is really no true ground with you guys. spin, spin, spin
Michael:
I do not believe you can say it as you said it in terms of population percenatges. The Department of Health did a rather nice study in 2002 which breaks down those costs. Again what you are stating here is a generality when in it reality it is a much smaller percentage. Furthermore I beleive you have to break it down even father than just the elderly.
I am going to guess here and say your 5% stat is within each age group and the percenatge of that 5% for each group is shown here: http://www.ahrq.gov/research/ria19/expriach2.htm Your explanation alludes to it being only within the elderly. If you notice it does drops off rather dramatically after 79. Amongst the 5 percenters, the group between 65-79 years of age.
Rather than recite, I will C&P:
“The elderly (age 65 and over) made up around 13 percent of the U.S. population in 2002, but they consumed 36 percent of total U.S. personal health care expenses. The average health care expense in 2002 was $11,089 per year for elderly people but only $3,352 per year for working-age people (ages 19-64). Similar differences among age groups are reflected in the data on the top 5 percent of health care spenders. People 65-79 (9 percent of the total population) represented 29 percent of the top 5 percent of spenders. Similarly, people 80 years and older (about 3 percent of the population) accounted for 14 percent of the top 5 percent of spenders (see chart). However, within age groups, spending is less concentrated among those age 65 and over than for the under-65 population. The top 5 percent of elderly spenders accounted for 34 percent of all expenses by the elderly in 2002, while the top 5 percent of non-elderly spenders accounted for 49 percent of expenses by the non-elderly.” http://www.ahrq.gov/research/ria19/expendria.htm#diff1
It is a little different than how you stated it and when examined, we can begin to ask the why about the high percentage of cost consumed by a smaller percenatge of the population within each age group and overall. This isn’t a critique of you by-the-way, I apologize if it appears as such.
continued:
The study also stated: “In 2002, the top 5 percent of the population accounted for 49 percent of health care expenditures.” This particular citation (from the same study) would fit more closely with what you are saying. Your bringing this in on a discussion of the elderly somewhat blurs the issue. However, it is good to understand “why” such a small percentage of the total population across all age groups would have such a high percentage of the healthcare cost.
The top five disorders in 2002 appear to be:
– mood disorders
– diabetes
– heart disease
– asthma
– hypertension
These 5 top-10 disorders or illnesses amounted to ~$63 billion in 1996 which is a little higher than the cost of malpractice lawsuits today; but, when they are compared to the cost of healthcare in 1994 (when Clinton attempted to pass healthcare reform) this is almost 10% of the cost of healthcare (~$600 billion) in 1996. When the other illnesses are added into the premise, the cost swells to $270 billion in 1996 or 49% of the total cost (I am being sloppy with percentages).
Furthermore, spending on one chronic condition is subtantially higher (study says twice as much for one) than on those with no chronic conditions and if all of the top 5 chronic conditions are present, than the cost expands exponentially (14 times). A greater percentage of the elderly have more chronic conditions, and > than 1, than the non-elderly. in 1996 25% of the total population had one or more chronic conditions. Just think of what this means for the children and the poor of today raised or sustaining themselves on cheap fatty and sugar ladened fast food in the future and the imact on healthcare costs. We expend people to raise themselves up by the boot straps and we want our freedom to east “shit” without any thought to the consquence of our actions or societal beliefs.
But “why,” why are these 5 chronic disorders prevalent? another study looking at 1987 to 2000 found these five disorders accounting for 31% of the total cost of healthcare.
– heart disease
– pulmonary disorders
– mental disorders
– cancer
– trauma
One conclusion reached was the number of people being treated for the top 15 chronic conditions. Why?
– “The continued rise in the share of privately insured adults classified as obese.
– Changes in clinical treatment guidelines and standards for treating patients without symptoms or with mild symptoms only.
– The availability of new medical technologies to diagnose and treat patients.”
I am off on a tangent and I will conclude with this C&P:
“From 1987 to 2002, the proportion of the population treated increased 64 percent for diabetes (accounting for 80 percent of the increase in costs) and increased 500 percent for hyperlipidemia (accounting for almost 90 percent of the increase in costs). A number of factors might explain the substantial increase in treatment rates for conditions linked to obesity. These factors include a rise in the number of people with obesity-related conditions, a rise in the number of more seriously ill patients, a greater emphasis on preventive care, and the introduction of broader treatment options.”
It appears a change in life style may help?
Michael:
You again are ignoring the cost/benefit ratio for a treatment which in some cases is extremely loss for some of the treatments, pharmas, and devices. Given there is not (to my knowledge) a 90 or 95% of success for a particular treatment or pharma’ it would appear that some percenatge of result is acceptable and some is not when cost is taken into account. In such comps, coberly’s statement has merit.
As I pointed out before, the medical industry has not been held to any cost/benefit ratio for the devices, pharma, or practices it has put into use as it has always enjoyed an open pocket book.
You also raised the issue of “who decides on treatment” when siblings demand addition treatment? If the patient is mentally competent, the patient decides what treatment they warrant. Doctors first have to follow the patient’s requests legally, documentation secondarily, and a guardian’s wishes in the third. I do not believe progressives have such a hard time understanding that scenario.
The issue today is the inflation of medical cost as compared to the treatment received and the practice utilized. This is the limitation on doctors as the cost of healthcare is exceeding the growth in the economy. Coberly’s premise has roughly stated this.
Michael:
Any chance you can use a salutation so we know who you are speaking to??? 🙂
Thank you!
Run,
I think its a bad judgement call since even though he clearly stated his opinions are his own by name dropping this famous institution he’s using it to enhance his credibility and by doing so is representing this institution without its permission.
Run,
I think its a bad judgement call since even though he clearly stated his opinions are his own by name dropping this famous institution he’s using it to enhance his credibility and by doing so is representing this institution without its permission.
In George Washington’s day the medics used the leeches.
Today they became the leeches.
$690B US Government 2009 outlays for National Defense (Mini Truth code for Haliburton bottomline): Not including incidentals like the undecalred wars of error and occupation. Most of this borrowed!
$680B Social Security Outlays 2009:
$431B Medicare 2009 outlays:
Mayo don’t need a chunk of medicare, it should be selling slugs and thugs to the pentagon.
MM, without the benefit of this marvelous bill 27% of Drs already choose not to accept Medicare. An even higher (much) percentage of Drs do not accept Medicaid. You really should read the article.
Well, that is not my dissertation research, which is a comparative effectiveness evaluation of providers. But I also sit on my departmental IT committee. Mayo, I can assure you, is QUITE up to date on technology. Another paper I am writing is on the use of “Computerized Clinical Decision Support Systems; Primary Care Workforce Implications”. There is much technology can contribute, but a lot of it is still in development.
Cantab, that is not correct. I believe in several posts, I stated where I was re-iterating our Health Policy Center’s position, and where I was speaking for myself. This thread began with some bashing of the Mayo Clinic, and I was responding to these specific criticisms. In most other instances, I am speaking for myself, and not Mayo.
Run, There are several treatments with a 90+ percentage success rate. Total knee and hip arthroplasties come to mind. These remain some of the most successful surgeries done, with over 90% success at 10 years postop. Yet, reimbursement is not stellar, and spine surgeries with a much lower rate of success, are reimbursed better. This is but one example.
Secondly, while in theory, we are supposed to follow documentation secondarily, this not commonly followed. The reason being, as one physician during my training back in Ohio alluded to, was that “Dead people don’t sue”. If we have a family speaking contrarily to the documented wishes, it creates a very difficult situation. Which is why counseling of the family by the patient PRIOR to any hospitalizations is SO important.
Run, it is certainly NOT only within the elderly population, that 5% statistic is representative of the population as a whole.
As far as a change in life style? Well, I’m not going to hold my breath, but after almost 15 years in EM, I have very little faith that patients will change their behaviours. We, as a society, are too fat, eat too much cr*p, drink too much, and exercise too little.
The scariest thing to me, is the childhood obesity epidemic which is reaching scary proportions.
Ilsm, I haven’t done a post hoc on this study, but this is the one most frequently cited. Please feel free to read it. It is by Hogan, and was published in Health Affairs in 2001.
http://content.healthaffairs.org/cgi/content/full/20/4/188
Ilsm, I haven’t done a post hoc on this study, but this is the one most frequently cited. Please feel free to read it. It is by Hogan, and was published in Health Affairs in 2001.
http://content.healthaffairs.org/cgi/content/full/20/4/188
Run, please understand, I am supportive of the legislation as a starting point, which is really all it is. As far as increasing apathy, this is not of course my intent. My concerns over Medicare are just the result of frustration from 20 years of seeing several Medicare initiatives go nowhere. I hope that it does change now. I really, really do.
I like the AMT – it hits Blue states far more than Red States…
Islam will change
MM,
Here in reality based world, Medicare is not accepted in high cost of living areas. I have moved around a lot, use Tricare, and have found and almost 1 to 1 correlation between the cost of living and acceptance of Medicare/Tricare. In Shreveport everyone took both. But you could easily buy a 4 bedroom 3000 sq ft home on 1/3 – 1 acre for $200K. In Northern Virginia the number of Drs who would accept either was much. much lower. And none (i.e 0, nada, zilch) of the Doctors practices that were considered good-excellent (by the professionals I lived among and asked for referrals when moved in) would take Medicare/Tricare. Why? They lost money on every patience becuase the re-imbursement rate was so low. Yes you could find some single-person, speaks English as a second language practices in the not-so-nice part of town that would take them.
Some doctors would keep Medicare/Tricare patients they had but would not accept more.
Bottom line that 27% I bet are clumped in high cost of living areas and are the best doctors. And yes MM doctors can easily survive without EVER seeing a Medicare/Tricare/Medicaid patient. And more will….
Islam will change
Michael – Glad you understand how Old Palin, even though over-the-top, was correct about the government “death panels” coming to you.
I really have no problems with that as long as I can buy what ever I can afford even if the Governments rationing panel says they won’t pay. (Though your congress critters will be exempt as usual…)
So we are starting to get the answer to my long standing question: “What will we let poor grandma die from that rich grandma can get and live another 6 months or 6 years just becuase she can write a check?”
Seems the government rationing panels ,oops, sorry, “Optimum Care Distribution Committees” (aka “Death Panels”) will be coming to a reality based future…
Islam will change
Michael:
We have common ground. I agree and I hope there is a chance to force a change.
Michael:
The payoff for dead people is far less than the injured. I understand the documentation part. Saying good-by is a tough deal.