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Thursday, July 30, 2009

BREAKING: Foreign born Radical Communist Obama wants to kill Grandma and Grandpa

Sometimes you just have laugh, notwithstanding the lack of actual humor in the circumstance. I recently had my bit of Photoshop fun with this inane "Birther" thing (regarding people who continue to increasingly insanely claim that Barack Obama was not really born in Hawaii to an American citizen mother and, consequently, cannot be our legitimate President).
 Click to enlarge.

Now we get to put up with the equally idiotic "Deathers," people who claim that health care reform will result in forced euthanasia of the too-costly, expendable elderly, e.g., GOP House member Virginia Foxx of North Carolina:

and the unbelievably hokey Family Research Council's "After A Government Health Care Takeover":

LOL. In terms of "acting," next to them, Harry and Louise look like Oscar nominees.
BTW, Mrs. Foxx and FRC, my personal, actual "pro-life" bona fides are succinctly documented here.

OK, back to serious health policy reform discussion. It takes something less than rocket scientist acumen to ascertain that health care expenditures are to a significant degree correlated with age. As I noted in a previous post, my health care CQI mentor Dr. Brent James long ago pointed out that, on average, roughly 80% of a person's lifetime health care expenditure comes during the last six months of life. I would today call that A Binding Glimpse Of The Obvious.

Consider the following graphic, from UCSC:
31 nations, rank-ordered, high to low (L-R) in terms of "average life expectancy" as a function of per capita cost expressed in currency-adjusted "International Dollars" (Note: I drew the black "trend line" through the chart in Photoshop. Eyeballed it -- not having access to the underlying data -- and I tried to visually ignore the U.S. "outlier"). What is noteworthy here? Well,
  • the life expectancy range, or "spread," is about 5% from the highest to the lowest (Japan to Portugal);
  • The United States ranks near the bottom, notwithstanding far and away the highest per capita cost (again, as we have discussed before, roughly 2x the otherwise average);
  • cost, while a salient contributory factor, is nowhere near determinative; e.g., Cuba's spending is nil relative to ours, all the while their having essentially the same average life expectancy. Moreover, Japan, ranked highest in life expectancy, appears to be around the average in terms of per capita expenditures. Myriad other elements are clearly at play. In general, one needs to be aware of the post-hoc, ergo propter hoc fallacy ("correlation=causation"). This very graphic refutes it -- i.e., given U.S. expenditures, Americans ought easily all survive into our 90's and beyond, given the money spent;
  • just for a thought, visually take out the extreme high/low cost outliers of the U.S. and Cuba in your mind's eye, and then also visually "connect" my informal trend line from Japan (highest longevity on the left) to Portugal (lowest, on the right). The "slope" -- which would pretty much run through the center of the amended distribution -- would be close to flat, i.e. the correlation would be next to nil.
What can you rationally take away from the foregoing? [1] Older people cost more to care for (duh, hel-LO?); [2] Other nations do it far more efficiently and effectively overall -- and without having to resort to heartless, whiney "Kill Grandma" canards.

Spare me.


"When the government gets involved in health care, things go rapidly downhill."

- Standard GOP obstructionist talking point.

OK. Here's the relative distribution of private vs. public health care expenditures since 1997:
Roughly half of health care expenditures (45% vs 55%) have been publicly funded across this period. I was going to graph it, but it's pointless, the trend lines are flat. You can see that right there in the table. [Source: HHS (pdf), click the image to enlarge]

Below, for historical context. In 1960, 3/4 of NHE were "private." Medicare came to the sociopolitical landscape in 1965, and subsequently, as the population has aged, the relative proportions have indeed shifted inexorably in the direction of public funding.

The point? We have had Medicare for 44 years. It works (and is going to have to continue to do so, as its share of the patient population grows with the incipient huge eligibility wave of the Baby Boom generation). We have had a Veterans' Administration since 1930. It works. No, neither or them perfectly. But they effectively serve their intended functions. Which is that of serving their beneficiaries, rather than the portfolio accounts of for-profit stockholders.


I have quite a bit more than just a passing familiarity with health care costs. I have been studying many of the issues professionally since 1993 (see my prior posts), when I took up my first tenure as an analyst with the Nevada-Utah Medicare QIO, where much of my work initially involved analytical data mining of the Part-A acute care hospitalization claims databases (today known as the CMS ISAT data).

Then, in the spring 1996, I was summarily thrown into the world of the medically indigent as next-of-kin caregiver to my terminally ill daughter, Sissy. Later that year, my then- 80 yr old Dad came to the brink of dying from heart valve failure. An aortic valve replacement and bypass would forestall his demise.

Sissy died in 1998 in the wake of a horrific and expensive struggle against metastatic liver cancer (paid for mostly by federal and California taxpayers via Medi-Cal). Notwithstanding that we were not legally on the hook for Sissy's expenses, still, we wearily shlepped back to Vegas from Hollywood in the summer of 1998 tens of thousands of dollars in debt in the wake of the experience.

Several years later -- the day after the 9/11 terror attacks in 2001, to be precise -- my Dad, who'd never fully recovered cognitively from his heart surgery, keeled over at home in Florida in cardiac arrest. EMTs revived him, and, after several week in acute care, he was transferred to a nursing home, where he would subsequently languish for years in an increasingly befuddled, often shit-and-urine-soiled state of dementia.

Fast-forward to 2004, where my Mother, then 82 and increasingly enfeebled, would spend most of the fall in revolving-door acute and rehab unit care (and I would spend much of my time on the Delta red-eye from Vegas to Melbourne). An attorney drew up the papers appointing me her Attorney-in-Fact, and I would subequently end up increasingly running most aspects of her logistical and financial life. In December of 2004, doctors would forestall her demise via a pacemaker implant. She'd gotten so wobbly from her increasing cardiac instability that she'd become a constant, serious fall risk. She'd already had one hip replacement. Another fall might well kill her.

In 2007 I moved them both to Las Vegas, Pop to a nursing home, and Ma into assisted living. She lasted all of 9 days. Fell while in the bathroom, and was transported to nearby St. Rose hospital, whereupon she suffered a recurrence of the enervating C-diff infection and UTI that had kept her in Florida hospitals most of the first six months of 2007. She spent the remainder of the year in and out of hospitals and rehab facilities.

My requisite POA pen ever at the ready.

She never made it back to assisted living (I wasted ten grand on that Quixotic effort; her remaining furnishings and effects we'd shipped from Palm Bay and lovingly moved into her new apartment now sit in a storage unit a few blocks from my house). Mother is now bedridden and wheelchair-bound in a nearby nursing home.
Private pay (Medicare does not pay for long-term care). I now cut a check for about $6,300 a month on her behalf. She's now 87. I sit with her nearly every day, ongoing.

Dad finally died last year, just shy of his 92nd birthday, and five months after I'd spent close to $4,000 in legal fees to obtain Legal Guardian status, owing to my concern that my POA on my Ma would die with her, and he had no legal cognitive ability to grant me POA on him (she had it on him, but it was non-transferable to me).

Just one personal story. And, I have not the slightest doubt that I'm in extensive company
(increasingly so). The ethical issues and quandaries pertaining to the just allocation of health care resources are myriad and maddeningly complex (I addressed that two posts ago in citing the 1994 works of Elhauge and Dr. James). These serious sociopolitical issues deserve orders of magnitude higher-level policy discourse than those proffered by the ignorant, cynical likes of a Virginia Foxx or a Family Resource Council.

My kin have undoubtedly "cost the health care system" millions during the past dozen years or so. How much of that went into actual necessary clinical care and its requisite support services, and how much went into the multi-million dollar compensation packages of for-profit "health care" executives, I have no formal way to calculate. But, look at the "Cost of a Long Life" graphic above.

What would you estimate?


Sometimes, the sheer willful, unreflective ignorance just leaves you shaking your head. I just saw this photo over at Jon Taplin's blog. It's of a piece with the recent rantings of the numerous "Town Hell" shouters angrily crying 'keep your government hands off my Medicare.'

Well, sir, perhaps because

  1. He's not a Canadian citizen, and,
  2. in addition to his generous insurance provided by the federal employee health insurance program he has as a member of the Senate, he's a MEDICARE BENEFICIARY!


"The discoveries of healing science must be the inheritance of all. That is clear. Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion. Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available."

- Prime Minister Winston Churchill, March 1944, arguing for the establishment of a British National Health Service.


jrobinson said...

This is fantasy at its best. Socialized medicine systems in other countries deny coverage to old people all the time; it's virtually a hallmark of the approach. It's called "quality adjusted years remaining". Look it up.

You cite Medicare and the VA and evidence that the government does a good job? Jesus, I almost fell off my chair. I still remember when the infamous "building 19" at the VA was hung around Bush's neck as "proof" he didn't care about vets. Remember the days when the failure of the VA was an excellent club to beat Bush with? But now, it's a badge of quality or something?

Medicare is bankrupt. Out of money. Kaput. It's been widely known for some time. In fact, when you lefties carp about health care costs being "out of control", these are the costs you are referring to.

Medicare - a government program to bring health care to those who can't afford it - is just a ponzi scheme, rapidly collapsing under its own weight. Good thing the new government program to bring health care to everyone will be different. Whew! Problem solved!

I am amazed at how boldly you assert the exact opposite of reality... and the brilliant way you take failures such as Medicare and turn it into solid gold.

BobbyG said...

Thanks for your comments, John. The ad hominem "you lefties" is a dead giveaway for the shallow name calling-mentality typical of the more unthinking opponents of any kind of sociopolitical reform. I am a dead-center moderate independent whose lifetime voting record spans the gamut from Democratic to Republican to Independents to Libertarians. I am far more concerned with integrity and results than ideology. And, as an analyst and writer, I am more concerned with empirical matters than ideology.

BTW, sorry to inform you that Building 19 (Walter Reed Medical Center) was Army, not VA. Big difference.

"Socialized medicine systems in other countries deny coverage to old people all the time"

Doesn't happen here under Medicare. Sorry, again, I know WAY about this than do you, both professionally as a former Medicare QIO analyst, and as caregiver and Attorney-in-Fact to my Mother. I was also Legal Guardian to my disabled WWII veteran Dad. He was 100% VA covered, and they took good care of him.

Don't hurt yourself falling off your chair. Your private insurance claim may well be denied.

Final thought: that Medicare may arguably be actuarially "bankrupt" soon has everything to do with Congress and zilch to do with CMS administration. And, the last time I checked, there were no Medicare administrators and execs pulling down 8 figure compensation packages. Big Insurance and Big Pharma typically shower congressmen and women with more money than the typical CMS administrator earns in a year.