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January 10, 2005

Saving Money on Health Care

Matt retreats a bit and admits that improving health in society does, as I noted, save society money by saving us the costs of illness by productive workers. But then he changes the subject and admits that his real point is that spending money on people who are going to die anyway doesn't do much for the budget bottom-line:

The desperate measures taken near the end of life are very costly. And, to raise a point I've raised before, physically healthy people have a tendency to spend years and years requiring very costly nursing home care because of alzheimer's and whatnot.
Some commenters hit the obvious point that curing alzheimers is hardly an impossibility-- and would de facto extend the effective lifespan of people. But I think the heart of his complaint is that we don't allocate our health care funds intelligently, which I can't disagree with, but that's a different point from saying that spending on health care is not effective in general.

Matt ominously talks about marching "forward into command-and-control supply and price management", but we are already there. It probably isn't the right balance of what health care is allowed and what is denied, since we no doubt should be spending less on extreme measures and more on childhood health and nutrition.

I'm a bit influenced by the experience of my Mom, who passed away just a year and half ago.

She had been on the road to dying for years from emphysema. The oxygen machine and home delivery of oxygen (for her portable tank), while mildly expensive for Medicare, seemed like a very efficient use of health care funds, since it allowed her to stay out of expensive nursing homes and remain independent-- something she was pretty fierce about. Unfortunately, in her last year, she became less mobile, but Medicare doesn't cover visits by aides to help on day-to-day self-sufficiency. Maybe she would have ended up in the hospital soon in any case-- she lived longer than her original prognosis -- but I know the panic of feeling less independent seemed to speed her hospitalization.

A big expense that Medicare had denied years earlier was surgery on her lungs that sometimes extended life and helped some emphysema sufferers off oxygen but was often unsuccessful. Since it cost as much as $100,000 for uncertain results, this denial of care by Medicare seems exactly the kind of hard choice that Matt and other health cost restraint advocates would support.

Since we don't actually have national health care and the money saved doesn't necessarily go to childhood vaccinations, I'm less personally at ease with the decision, for obvious reasons. But that's one of the problems with having a health care system like Medicare aimed just at the elderly. Many seniors might be more supportive of cost controls if the purpose was actually better health care for everyone, including their grandkids, but when the purpose is just abstract deficit savings, it's hardly surprising that they fight for every dime they can.

The final issue was care once she was hospitalized. The actual hospital bills for about a month in the hospital were obviously large -- paid by Medicare -- but the taxpayers were saved most extraordinary costs after my Mom had a heart attack. Which is somewhat what she wanted, since she had always said that she didn't want to live if it was only based on extreme measures. She confessed to a neighbor before one round of proposed surgery (which never happened) that she sort of hoped she wouldn't survive it. My general comfort with a harder look at the costs of such extreme measures is no doubt influenced by my Mom's disdain for them.

But Matt should be clearer that our health care problem is that we as a nation spend possibly too much on seniors, for whom the marginal cost for extension of both the length and quality of life is high, and we spend far too little on health and nutrition for the young.

Matt complains about "America's mixed public-private health care system," but since we don't have a unified health budget for all ages, talking about a "system" singular just confuses the discussion.

Posted by Nathan at January 10, 2005 06:58 PM