But on to more pressing matters...I'm not a doctor. Given that mea culpa, is it actually true that smokers and fat people cost more? As an example, I have 98 and 97 year old grandparents who are still doing quite well, are thin, and except for the fact that my Scottish grandma gave up 2 scotch and waters every day at the age of 90, have lived very healthy lives. They have also been on prescription medication for damn near 1000 things for 20 years now. I'm actually unsure if they aren't a far greater strain on the system than a smoker who dies at 55.
I mean, we ALL die...and with fat people and smokers dying earlier, are there up front costs that much higher than the people who get parkinsons, have heart problems, blah blah for 25 more years?
Uninformed question, but it just seems like we compare the costs of a smoker dying against a healthy person as though that person will never die, be on drugs for years, go through 5 years of chemo and hospice, etc.
I was told
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Smoking does indeed increase cost on average to provide care, Eric--there are many additional things that smokers are prone to developing aside from lung cancer. Rob, they do die earlier, but often cost the healthcare system beaucoup dinero before that occurs. Poorly controlled diabetes also costs the system enormous amounts.
But I just talked to the former three term governor of Colorado who told me that they do cost less. So i'm back at my hotel room google searching.
A Dutch study published last year in the Public Library of Science Medicine journal said that health care costs for smokers were about $326,000 from age 20 on, compared to about $417,000 for thin and healthy people.
The reason: The thin, healthy people lived much longer.
Willard Manning, a professor of health economics and policy at the University of Chicago's Harris School of Public Policy Studies, was lead author on a paper published two decades ago in the Journal of the American Medical Association that found that, taking into account tobacco taxes in effect at the time, smokers were not a financial burden to society.
"We were actually quite surprised by the finding because we were pretty sure that smokers were getting cross-subsidized by everybody else," said Manning, who suspects the findings would be similar today. "But it was only when we put all the pieces together that we found it was pretty much a wash."
Such conclusions are controversial since they assign an economic benefit to premature death. U.S. government agencies shy away from the calculations.
The goal of the U.S. health care system is "prolonging disability-free life," states the 2004 Surgeon General's report on the health consequences of smoking. "Thus any negative economic impacts from gains in longevity with smoking reduction should not be emphasized in public health decisions."
Intuitively I simply KNEW that dying 10 years earlier HAD to be less of a strain on our system than being on prescription drugs all 10 years.
Food for thought.
Thanks, interesting. A really big concern is discussed in a recent Time Magazine. (Looking for the link), last two years of health care vary from about $53K at Mayo Clinic to about $100K for the whole east coast and southern band of states, including California - and about ALL of Texas. And this is for NO measurable improvements in outcomes.
It really strikes me as non-patriotic to spend that much money of our fellow citizens and get nothing in return. And living in a fairly low cost of medical expenses state, I am not particularly happy about subsidizing those who waste money. All of this confirms my prejudice that the government cover basic medical care that ensures the 95% will survivie to 80+ or so; And that patients and parents have the choice to buy private insurance if they want to be high spenders.
I was talking about health care today with a woman in my office. Apparently her church is railing against a public option. We talked and I told her that one of my big problems with health care is the concept of hospitals as profit centers. Hospitals design procedures in such a way as to gain the maximum profit from their "plant".
Besides, there is no difference between an insurance administrator getting between a doctor and patient and a government official. I had to pay $12,000 for medical treatment that exceeded my insurer's authorized physical threrapy allowance. I don't think the government would have been any less flexible.
I think it's the same bullshit that anything proposed by the state is automatically bad. Her church is very fundamentalist conservative. I think they spend most of their time looking for the mark of the beast in everything. Interestingly, she and her husband are very nice intelligent people. They just have a huge blind spot. I am not an anti religious person. I am a Christian and I belong to a Brethren congregation, but I just don't look for the end times and the antichrist under my bed every night.
There are a lot of examples of that, Bob. Unfortunately. Everyone wants to use the latest and greatest, when no evidence exists to support a true difference in the outcome.
So, just a rhetorical question: all this cutting edge pharma and tech that we're on top of here.... who cares if A: it costs too much and B: it has no survival or morbidity benefit?
So, just a rhetorical question: all this cutting edge pharma and tech that we're on top of here.... who cares if A: it costs too much and B: it has no survival or morbidity benefit?
The biggest issues, to my why way of thinking, are in regards to the rational provision of medical care. We tend to be conditioned to believe that aggressive and/or expensive treatment is always the most beneficial, but this is often clearly not the case.
That which provides no benefit in regards to morbidity and mortality generally lacks a rational basis for utilisation, regardless of cost. That which demonstrates proven benefit must be assessed in the "bigger picture", e.g., are there equally effective, cheaper alternatives? While the treatment may be beneficial for a given illness, is it of benefit for the patient as a whole (examples would include agressive treatment of illness in a patient with advanced Alzheimer's----I've seen this situation numeorus times in my career)? And, unfortunately, we have to ask, can we afford this treatment for the general populace (i.e., an highly effective treatment may be so expensive as to not be affordable to offer to any except those who can pay out of pocket).
In the interests of full disclosure, it should be kept in mind that my own job places me in a position whereby I earn a significant portion of my income reporting diagnostic tests which are likely to be of little or no value to patients. It is estimated that roughly 25-40% of imaging tests lack a clinical rationale, but I get paid regardless. Attempting to prevent these tests from being performed is almost impossible---I would spend my entire day on the phone arguing with referring physicians and would likely face an enormous number of complaints to my hospital administration if I were to do so (FWIW, demand is sufficiently high for services in my specialty that we could fill the gaps created by eliminating needless tests and lose little to no income). It should be noted, though, that I don't request diagnostic studies, I merely interpret those referred to my department, so at least that potential source of an ethical dilemma due to self-referral is out of the picture.
Americans and our political class have no desire to address cost controls, rationing, responsibility or entitlement reform. Even if we had health care reform that addressed the example in the article, how would any government program that “denied” care survive the “oprah effect?”
[oprah effect – there no situation that can’t be trotted out in the national media in a way that endears great if not unlimited support to fix the situation of a single poor unfortunate soul]
Prostate Cancer funding / treatment is a great example of why we (Americans) are more likely than not to completely screw it up. There will be advocates for sexual parity (comparable $$ and plans for both Breast and Prostate Cancer treatments). There will be advocates for treatment options that do not discriminate due to age. There will be advocates for….hell ….just about anything you can dream of!
Russ - nice post. I do wonder that if guidelines could be devised that increased co-pays as the treatment/diagnostics were less supported as beneficial. My suspician is that there would not have to be much increase in order to reduce unneeded medical services.
I do wonder that if guidelines could be devised that increased co-pays as the treatment/diagnostics were less supported as beneficial. My suspician is that there would not have to be much increase in order to reduce unneeded medical services.
The problem I have with that approach is that it penalises patients for certain poor habits among physicians. As an example, MRI of the lumbar spine is a grossly overutilised test. With your scenario, the subgroup of patients who actually need this test (which is thought to be roughly 25% of those who atually undergo the test!) would be forced to pay a premium for it, since it's unlikely that co-pay would be determined on a case by case basis as such a process wuld be onerous.
So each of us should be responsible humans and do a cost/benefit analysis of possible treatments should illness occur.
That's a difficult thing to do when in the throes of illness. There's a tendency when ill to place increased value on treatments which may not be effective in the name of remaining hopeful.
I found this article interesting, and expressive of my own values. The nuns for the most part reject heroic medical treatment, and are surrounded by a community affirming their own values at the end. The article points out that this 'way of dying' does not need to be limited to those in religious communities.
But if the treatments have roughly similar benefits, they have very different prices. Watchful waiting costs just a few thousand dollars, in follow-up doctor visits and tests. Surgery to remove the prostate gland costs about $23,000. A targeted form of radiation, known as I.M.R.T., runs $50,000. Proton radiation therapy often exceeds $100,000.
I simply cannot understand that patients (or doctors) would have a free choice to choose the most expensive option above, at least without a very large co-pay, particularly when there is no real difference in outcome. Disclosure: I, and father and brother, had surgery for prostate cancer. I was happy that insurance covered the surgery. But by what distorted reality should a person be able to choose an option about $100,000 over the cheapest.
Likewise while I have diabetes I can inject small amounts of insulin several times a day, and maintain better control than about anyone on the web sites where I follow diabetes. It is absolutely politically incorrect to suggest that a person ought not to be entitled to having an insulin pump and/or continuous glucose monitors at $5000 for the hardware and $350 a month in supplies (not counting insulin), similar fees for the monitor. My costs, $30 syringes (Walmart), and $150 monitoring supplies (which I could reduce to $65 if insurance let me do a little shopping). In both cases one has to add the cost of insulin, in my case about $135. Note: I pay less than this as I have fairly good insurance, but then I have contempt for medical people/ other patients who teill me to spend more because insurance will cover it.
Note: there are reasons when people do need insulin pumps or continuous monitors.
Did no one else read this on CNN? Socialized medicine rules!
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After suffering from crushing headaches and vision problems, she was diagnosed with a brain tumor four years ago. She was told if it wasn't removed, she could go blind or even die.
"They said to me that you had a brain tumor and it was pressing on your optic chasm and that it needed to come out immediately," Holmes said.
Holmes is Canadian, but the "they" she refers to are doctors at the Mayo Clinic in the United States, where she turned after specialists in her own government-run health care system would not see her fast enough.
"My family doctor at that time tried to get me in to see an endocrinologist and a neurologist," Holmes recalled. "It was going to be four months for one specialist and six months for the other." Watch Holmes talk about her experience in getting treatment »
Even with the warning from U.S. doctors in hand, Holmes said she still couldn't get in to see Canadian specialists. Because the government system is the only health care option for Canadians, she says she had no choice but to have the surgery in the U.S.
Nice Canada has a 3000 mile border so that this can be easily done. To bad the 46 million in the US without insurance can't go up to Canada for free medical care.
Nice Canada has a 3000 mile border so that this can be easily done. To bad the 46 million in the US without insurance can't go up to Canada for free medical care.
But it's hardly free, though. After all, I'm taxed at a significantly higher rate than you are and the Canada's health care system is increasingly cash strapped as medical technology advances.
FWIW, I'm not of the impression that the Canadian system, which is too heavily socialised, IMHO, is what's being proposed. It looks more like a blended system akin to what's common in Western Europe. My own preference is a blended system. The Canadian system offers too little choice and is often stymied by long waiting lists and poor access to specialist consultation. The system in the US is a behemoth whose costs are significantly higher as a percentage of GDP, from what I understand, than other western nations, and doesn't always adequately serve those in greatest need.
I found this article interesting, and expressive of my own values. The nuns for the most part reject heroic medical treatment, and are surrounded by a community affirming their own values at the end. The article points out that this 'way of dying' does not need to be limited to those in religious communities.
Rob, that was a great article. Thanks for sharing.
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A former top insurance exec was on Bill Moyers last night talking about how the industry have lobbied the Democrats hard to not support any meaningful changes, and how evil that 'ol villain Michael Moore is.
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^^Why is her church railing against a public option
Because if you know anything about Christianity you know that Jesus taught about personal responsibility and everybody making his own way in the world. Jesus didn't need no damn socialism; Jesus just healed himself and everybody else.
It's all in the Neoconservative Edition of the Bible.
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It's all in the Neoconservative Edition of the Bible.
I suppose I am getting to be a bit of a crank on this issue, but again, using the term "Neoconservative" with reference to a domestic policy issue makes little sense, IMO, and goes to show how little meaning the word now has.
I suppose I am getting to be a bit of a crank on this issue, but again, using the term "Neoconservative" with reference to a domestic policy issue makes little sense, IMO, and goes to show how little meaning the word now has.
Ha. Kind of like "socialism" and "fascism" are used, eh? It's amazing how imprecisely this shit gets thrown about.
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