President Obama: In the Long Run, We're All Dead
If you were to look at the health records of all elderly Americans who died in a given period, say in the year 2008, you'd find that some had undergone surgery in the year leading up to their death, that others had received low cost treatments or hospice care, and still others received little or no medical care. But regardless of the treatment these aged patients did or did not receive, they all died. From this you might conclude that if everyone ends up dead anyway, we might as well send our elderly on the lowest cost route to that final destination. At least that's what the Obama administration has concluded. Betsy McCaughey writing in today's Wall Street Journal explains.
President Barack Obama's former budget director, Peter Orszag, told reporters in June 2009 that the president's plan to cut future Medicare funding would not be dangerous. He said that spending could be lowered by about 30%, to approximate what is spent in the lowest-cost regions of the country, without doing harm.
Mr. Orszag cited the Dartmouth Atlas of Healthcare 2008, which tried to prove that Medicare patients who got less care (fewer hospital days, doctor visits and imaging tests) had the same outcomes as patients who received more care. But the Dartmouth investigators had pulled the same trick as the Lancet investigators: They examined only the records of patients who died. By definition, such patients—regardless of their level of care—ended up the same: dead.
Acknowledging that there are of course real tradeoffs and ethical quandaries surrounding the discussion about appropriate care for elderly patients, McCaughey argues that it is irresponsible and dishonest to make a judgment call with incomplete data. Instead of looking solely at the health records of patients who died, it's essential to look also at the records of patients who benefited from surgeries and expensive treatment. Not surprisingly, a more complete set of data tells a dramatically different story.
Statewide studies in California and Pennsylvania have proven the opposite of what the Obama administration claims. They show that Medicare patients treated in hospitals that provide lower-intensity, lower-cost care have a higher risk of dying.
The California study, published in February in the Annals of Internal Medicine, found higher death rates from pneumonia, congestive heart failure, stroke, gastrointestinal hemorrhage and hip fractures at low-spending hospitals. The study's authors calculated that 13,813 California patients treated for these conditions between 2004 and 2008 would have survived had they been treated at higher-spending hospitals rather than low-spending ones.
The Pennsylvania study produced similar results, showing higher survival rates at higher-spending hospitals.
At issue here, I think, is far more than the questions of whether or not elderly patients should continue to receive the highest quality care and who should rightfully decide. The question Americans should really think hard about as we move toward November, 2012 is whether they trust Mr. Obama with their very lives and believe him to be a credible authority on decisions concerning their health.
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Sep '10
Re: President Obama: In the Long Run, We're All Dead
In Canadian healthcare, someone who dies on the waiting list for a procedure improves the statistics.
Oct '11
Re: President Obama: In the Long Run, We're All Dead
It's frustrating that so much time and energy has to be spent to reinstate the obvious which has been obfuscated by previous studies that only exist to muddy the waters.
May '10
Re: President Obama: In the Long Run, We're All Dead
I'm mainly upset with the doctors. After all the fancy gadgets and big paychecks, they still haven't put a dent in the mortality rate. Show us some results, slackers.
Jun '10
Re: President Obama: In the Long Run, We're All Dead
The question Americans should consider is whether Mr. Obama is qualified to choose a brand of peanut butter off the shelf at the grocery store. Seriously, America has elected its first boy king. He's arrogant, pompous, clueless, and totally convinced of his own superiority. He might as well claim the power to cure scrofula in the manner of medieval kings.
May '10
Re: President Obama: In the Long Run, We're All Dead
In the words of former Surgeon General Jocelyn Elders, "We all will probably die of something sooner or later."
Re: President Obama: In the Long Run, We're All Dead
In a market-driven healthcare system, the patient is a revenue source. Under a government-run system, a sick individual is a cost.
If I contract a debilitating illness, I will be willing to spend a considerable sum on effective treatment. In anticipation of such an illness, I may amortize the expense by purchasing health insurance. Either way, my care is worth a lot of money to healthcare providers.
Under government-run healthcare, politicians care about winning votes. I get only one, same as everybody else. But most voters are healthy at any given time. They care about the promise of healthcare more than the reality. As long as the illusion exists that they will be cared for in the event of illness, the system works well for its "owners," the politicians, whatever the reality experienced by the seriously ill.
In practice, lost votes from dissatisfied patients and their immediate friends and family are balanced against votes gained from the worried well who buy into magical thinking and utopian promises.
In practice, a government-run system performs well in certain high-visibility areas--maintaining the illusion--while failing to provide adequate care to the most seriously ill.
Aug '10
Re: President Obama: In the Long Run, We're All Dead
I have an idea. Why limit such studies to the elderly? We can include all deaths in a given year and analyze to see if there were any long term benefits to higher cost medical care.
That 5 year-old who contracted whooping cough due to a lack of vaccination and died, that gang land shooting, and the long-term cancer sufferer. They all had the same result of health care. It didn't matter whether one received great healthcare and another neglected to use even low cost services. They all died in the final year of their lives.
Dec '10
Re: President Obama: In the Long Run, We're All Dead
Every second wounds; the last one kills.
I don't remember where I heard that, but it seems to fit.
Sep '10
Re: President Obama: In the Long Run, We're All Dead
In a market-driven healthcare system, the patient is a revenue source. Under a government-run system, a sick individual is a cost.
To riff on George's point -- as someone who experiences health care first hand in Soviet Canuckistan -- in a single payer system as we have, there is only one pot of money and everyone knows it. Hence, healthcare is viewed as a zero-sum game: for you to get more dollars allocated for your hospital, I must have gotten less. But, we have the constantly escalating costs of a unionized health care bureaucracy with defined benefit pension plans. And its not just the pencil pushers: the nurses are all unioned up in hospitals too.
So, here healthcare has become a rigged ponzi scheme like the education system: Government bloviate about "cost containment", while collective bargaining guarantees constantly increasing costs.
To quote Flannery O' Connor: "You can't get any poorer than dead."
Edited on Nov 1, 2011 at 11:36amOct '11
Re: President Obama: In the Long Run, We're All Dead
Pseudodionysius: In a market-driven healthcare system, the patient is a revenue source. Under a government-run system, a sick individual is a cost.
To riff on George's point -- as someone who experiences health care first hand in Soviet Canuckistan -- in a single payer system as we have, there is only one pot of money and everyone knows it. Hence, healthcare is viewed as a zero-sum game: for you to get more dollars allocated for your hospital, I must have gotten less. But, we have the constantly escalating costs of a unionized health care bureaucracy with defined benefit pension plans. And its not just the pencil pushers: the nurses are all unioned up in hospitals too.
So, here healthcare has become a rigged ponzi scheme like the education system: Government bloviate about "cost containment", while collective bargaining guarantees constantly increasing costs.
To quote Flannery O' Connor: "You can't get any poorer than dead." · Nov 1 at 11:35am
I think this confirms the broader principle as that in a free market people are resources and within a collectivist market they're generally viewed as drains. You meet very few conservative Malthusians.
May '10
Re: President Obama: In the Long Run, We're All Dead
Um, no, I do not trust Mr. Obama, nor do I trust the Federal government to decide for me the best care if and when I'll need it. I also don't trust the insurance companies, but at least with them I'll have a fighting chance.
Thanks for publishing this, Diane.
Aug '11
Re: President Obama: In the Long Run, We're All Dead
This is a very interesting piece. The answer is that Obama shouldn't be trusted. We have to trust someone, but probably not him.
But what will people say? The reason he has to make these cuts is because he inherited Bush's economy. And the reason he had to make these cuts is because the Republicans wouldn't say yes to anything. He tried to bargain with them and they were so against him.
I've tried stuff like this with people I consider reasonable, intelligent people who read a lot. The above talking points are really popular.