Healthcare Costs Rising

[Nanker]

Linky.

Employers evidently are trying to stay ahead of the curve.

[KD in CA]

Damn Republicans.

[birdog1960]

Damn Republicans.

might some of the increased cost have something to do with the FT's other article: US health insurers to make $200bn more?

[IDBillzFan]

might some of the increased cost have something to do with the FT's other article: US health insurers to make $200bn more?

That would be the tail end of the last 200B they're making before they go out of business as they're forced to immediately, and without question, pay for the health care of people with pre-existing conditions.

 

Imagine how grand it would be if you owned a private business that was about to be forced, by the federal government, to provide your services to people who will drain any profits you could ever wish to have on the promise that a bankrupt government will cover your costs.

 

Get wise, birdog. If Obamacare stays, private insurers will continue to make what they can and then close up shop. Just the way Obamacare wants it.

 

But hey...I'm sure the government will do a whizbang job when the schitt hits the fan in your life and the only people around to decide if and when you get treatment are the professional equivalent of a unionized airport TSA worker.

[EasternOHBillsFan]

might some of the increased cost have something to do with the FT's other article: US health insurers to make $200bn more?

 

Can't be the increased profit margins of drug companies? Naaahh.

[Alaska Darin]

might some of the increased cost have something to do with the FT's other article: US health insurers to make $200bn more?

In our fatter, more unhealthy society? Really?

 

Want to make health care cheaper? Try addressing the things that make it expensive instead of trying to create a boogie man so the government can take over. Nah, that's hard.

[GG]

might some of the increased cost have something to do with the FT's other article: US health insurers to make $200bn more?

 

And why are health insurers slated to make $200bn more?

 

Ps - is that in revenues, operating income or profits?

[John Adams]

In our fatter, more unhealthy society? Really?

 

Want to make health care cheaper? Try addressing the things that make it expensive instead of trying to create a boogie man so the government can take over. Nah, that's hard.

 

Not that he created the idea but Magox has been trumpeting this for a long time here: Think of how much money we'd save by investing in wellness over cures.

 

Heart disease, lung cancer, diabetes--top 3 killers in America...largely preventable with a healthy lifestyle. Add onto that all the back pains, orthopedic, gastrointestinals, skin ailments, sex drive, psycho-care--and a ton of this crap is 100% preventable with just a healthier lifestyle.

 

But instead of addressing, let's say obesity at its root, we agree to pay for all the care for obesity-related sickness instead, which is assinine.

 

My own peeve in health care is the amount of money spent and work done to prolong life a year or two at the end. Our doctors have no feel for when it's better to help someone die well than keep fighting and ruin their last few years.

[birdog1960]

 

 

My own peeve in health care is the amount of money spent and work done to prolong life a year or two at the end. Our doctors have no feel for when it's better to help someone die well than keep fighting and ruin their last few years.

respectfully disagree. it's not the doctors who insist on futile care, in most cases. it's the families and the patients. many people feel that anything can and should be fixed. this is a societal problem not a medical problem. and there's no one to say no...doctors can't be expected to make policy that the courts and gov'ts refuse to.

 

a study I saw yesterday (annals of internal medicine) showed most primary care doctors feel americans get too much care in general, not just at end of life. this is due to many reasons but most importantly reimbursement based on volume, malpractice threat and societal expectations.

[John Adams]

respectfully disagree. it's not the doctors who insist on futile care, in most cases. it's the families and the patients. many people feel that anything can and should be fixed. this is a societal problem not a medical problem. and there's no one to say no...doctors can't be expected to make policy that the courts and gov'ts refuse to.

 

a study I saw yesterday (annals of internal medicine) showed most primary care doctors feel americans get too much care in general, not just at end of life. this is due to many reasons but most importantly reimbursement based on volume, malpractice threat and societal expectations.

 

Respectfully agree in part. Certainly, many people push for maximum care. At the same time, doctors are wired to fight to the death (literally). I understand that malpractice muddies the water of a doctor's ability to advise continuing to fight when the quality of life during the fight is not worth it, but that's an important moment. Doctors rarely, if ever, seize it.

 

My perspective comes from my hoispice care wife, who works with lots of doctors and other health care professionals. Few doctors acknowledge or care to understand the concept of dignified death because in a way, it's anithetical to what they are trained to do.

[DC Tom]

respectfully disagree. it's not the doctors who insist on futile care, in most cases. it's the families and the patients. many people feel that anything can and should be fixed. this is a societal problem not a medical problem. and there's no one to say no...doctors can't be expected to make policy that the courts and gov'ts refuse to.

 

a study I saw yesterday (annals of internal medicine) showed most primary care doctors feel americans get too much care in general, not just at end of life. this is due to many reasons but most importantly reimbursement based on volume, malpractice threat and societal expectations.

 

 

Respectfully agree in part. Certainly, many people push for maximum care. At the same time, doctors are wired to fight to the death (literally). I understand that malpractice muddies the water of a doctor's ability to advise continuing to fight when the quality of life during the fight is not worth it, but that's an important moment. Doctors rarely, if ever, seize it.

 

My perspective comes from my hoispice care wife, who works with lots of doctors and other health care professionals. Few doctors acknowledge or care to understand the concept of dignified death because in a way, it's anithetical to what they are trained to do.

 

From what I've seen and read, you're both right. The root of the problem is that our society has real issues accepting the inevitability of both death and honest error, which leads to lots of unnecessary demands from patients and treatments from doctors. "Perfection" is hideously expensive...but Americans are too damned childish to accept anything less, and believe anything less must be someone's fault.

 

(And whoever responds to that with "Americans deserve perfection" or some such...thank you for proving my point, you childish dullard.)

[birdog1960]

doctor's ability to advise continuing to fight when the quality of life during the fight is not worth it, but that's an important moment. Doctors rarely, if ever, seize it.

 

this is just false. it is the rare exception in my experience for a physician to not seize that moment. most everyone i've ever taken hospital call with did and does. the advice is often ignored unfortunately. almost all hospitalists i've worked with are very aggressive in recommending against futile care. oncologists are a fairly frequent exception but this is understandable given the life expectancy and mortality rates of their patient population.

 

And why are health insurers slated to make $200bn more?

 

Ps - is that in revenues, operating income or profits?

it was revenue over the next 10 years largely do to the increasing enrollment estimates from the new health care bill. my point is that there is no need for this money to be spent. the existence of insurance companies isn't producing better or cheaper care. they just get in the way of efficiently and rationally allocating finite resources. this is $200 bn additional (to lord knows how many 100's of billions to start with) serving no purpose.

[John Adams]

this is just false. it is the rare exception in my experience for a physician to not seize that moment. most everyone i've ever taken hospital call with did and does. the advice is often ignored unfortunately. almost all hospitalists i've worked with are very aggressive in recommending against futile care. oncologists are a fairly frequent exception but this is understandable given the life expectancy and mortality rates of their patient population.

 

 

Well, I have only 12 years of exposure to hospice care at 5 hospitals surrounding a major metropolitan center. What do I know?

[birdog1960]

Well, I have only 12 years of tangential exposure to hospice care at 5 hospitals surrounding a major metropolitan center. What do I know?

fixed

[3rdnlng]

From what I've seen and read, you're both right. The root of the problem is that our society has real issues accepting the inevitability of both death and honest error, which leads to lots of unnecessary demands from patients and treatments from doctors. "Perfection" is hideously expensive...but Americans are too damned childish to accept anything less, and believe anything less must be someone's fault.

 

(And whoever responds to that with "Americans deserve perfection" or some such...thank you for proving my point, you childish dullard.)

 

 

Who do you suppose pushes this idea with TV ads and fights like hell with their lobbyists to prevent tort reform?

[BillsFanM.D.]

this is just false. it is the rare exception in my experience for a physician to not seize that moment. most everyone i've ever taken hospital call with did and does. the advice is often ignored unfortunately. almost all hospitalists i've worked with are very aggressive in recommending against futile care. oncologists are a fairly frequent exception but this is understandable given the life expectancy and mortality rates of their patient population.

 

I'll jump in. I agree with birdog in regards to doctors trying to prevent futile care. I've had innumerable lengthy conversations with folks where I've detailed a nil chance of survival. Rarely is that advice heeded. The typical response is just "well....do everything you can doc and we'll let the chips fall where they may." You rinse and repeat the conversation but many folks/society typically refuse to accept death as part of life. The care at that stage is often profoundly expensive and is a true drain on a soon to be unsustainable system. I consider myself a huge advocate of hospice and see it as a very underutilized service. Yes...it takes some nerve to speak of death directly to a patient. That challenge, however, doesn't mean docs don't do it. Of note, I'm married to an oncologist and I assure you she is a bigger hospice advocator than most.

[birdog1960]

I'll jump in. I agree with birdog in regards to doctors trying to prevent futile care. I've had innumerable lengthy conversations with folks where I've detailed a nil chance of survival. Rarely is that advice heeded. The typical response is just "well....do everything you can doc and we'll let the chips fall where they may." You rinse and repeat the conversation but many folks/society typically refuse to accept death as part of life. The care at that stage is often profoundly expensive and is a true drain on a soon to be unsustainable system. I consider myself a huge advocate of hospice and see it as a very underutilized service. Yes...it takes some nerve to speak of death directly to a patient. That challenge, however, doesn't mean docs don't do it. Of note, I'm married to an oncologist and I assure you she is a bigger hospice advocator than most.

to be clear, that was not meant as a knock on oncologists. they have one of the most difficult jobs in the world imo and i have much respect for them. there are some who fight on longer than others in cases with little hope. in most cases this is in response to patient wishes and can hardly be faulted. lastly, there are certainly differing definitions of futile care.

[KD in CA]

I'll jump in. I agree with birdog in regards to doctors trying to prevent futile care. I've had innumerable lengthy conversations with folks where I've detailed a nil chance of survival. Rarely is that advice heeded. The typical response is just "well....do everything you can doc and we'll let the chips fall where they may." You rinse and repeat the conversation but many folks/society typically refuse to accept death as part of life. The care at that stage is often profoundly expensive and is a true drain on a soon to be unsustainable system. I consider myself a huge advocate of hospice and see it as a very underutilized service. Yes...it takes some nerve to speak of death directly to a patient. That challenge, however, doesn't mean docs don't do it. Of note, I'm married to an oncologist and I assure you she is a bigger hospice advocator than most.

 

Which is why the decision should not be left up to the patient unless they are the ones footing the bill. Insurance should have a futile care provision.

 

I say bring on the death panels.

[Jauronimo]

Isn't that what normally happens when you invite 30 million people to the party who will not be contributing?

[BillsFanM.D.]

to be clear, that was not meant as a knock on oncologists. they have one of the most difficult jobs in the world imo and i have much respect for them. there are some who fight on longer than others in cases with little hope. in most cases this is in response to patient wishes and can hardly be faulted. lastly, there are certainly differing definitions of futile care.

 

I did not take it as a knock. I took it as a generalization about a field of medicine that faces 'this' issue more frequently than others. My wife, and most oncologists I've worked with, do an excellent job of providing the facts to families and patients. However, I've also known a few oncologists who will 'treat to the grave' so to speak. Why that occurs is very complicated. The poster you were bantering with seemed to imply it was the doctors 'fault.' At times it can be... but clearly MOST physicians do not want to participate in futile care. My mentioning that my wife (as an oncologist) was a big hospice advocate was more directed to the poster who felt doctors did not do enough. Most of these situations, IMHO, are driven by other factors.

 

Re: futile care: There was a thread here recently about living wills etc. My 'point' in that one was how do we define "in the event things are deemed hopeless." Whose definition? Whose values? etc. Everyone, in my opinion, should have a designated health care POA. One who can 'speak' to the doctors in what is always a fluid situation rather than a 'checklist' living will with vague yet supposedly rigid guidelines.