[Vision2020] Say What?

Tue Jul 28 10:28:39 PDT 2009

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Well, it's a little more complicated-- it's a combination of chronic disease & end-of-life issues.  As this Rand paper:

Adapting Health Care to Serious Chronic Illness in Old Age
Joanne Lynn, David M. Adamson
Rand Health White Paper WP-137 (2003)
http://www.medicaring.org/whitepaper/

points out, prior to modern medicine, most people died quickly after becoming ill.  With treatment for chronic diseases like cancer and diabetes people can be maintained for relatively long periods in their illness and it's difficult to say when the "end" will actually come.  Because of that, often people who are terminal are often hospitalized and heroic (and expensive) procedures initiated often to no avail.  The Dartmouth Atlas has documented regional differences in attitudes to end-of-life issues, leading to great disparities in health care spending:

http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm

"If you are dying in Miami, the last six months
of your life might well look like this: You'll see doctors, mostly
specialists, 46 times; spend more than six days in an intensive care
unit and stand a 27% chance of dying in a hospital ICU. The tab for
your doctor and hospital care will run just over $23,000.
But spend those last six months in Portland,
Ore., and you'll go to the doctor 18 times, half of those visits with
your primary care doctor, spend one day in intensive care and stand a
13% chance of dying in an ICU. You'll likely die at home, with the
support of a hospice program. Total tab: slightly more than $14,000."

This different attitude toward end-of-life issues is partially cultural, partially a result of the way our health care is "organized": more facilities and doctors= more "care". Oregon has taken a lot of heat for "rationing" and "encouraging suicide" in their state approach to funding health care.  We see the debate coming up over the cost of cancer drugs that, on the average, extend life for a month or two, but may cost $20,000 per month.  There was a recent case in New Zealand where the government denied access to one of these "wonder" drugs because they considered that the costs outweighed the benefits, which caused a great outcry in the press.  The pharmaceutical  company, seeing a great PR opportunity, provided the drug for free.  You see this being played out in the US where private insurance won't pay for treatments they consider experimental.  If we get additional national health care, the arguments will just be transferred into the political
 realm, as they are over the health care bills now in congress.

Ron Force
Moscow Idaho USA
P.S. Quote from USA Today: "Estimates show that about 27% of Medicare's annual $327 billion budget goes to care for patients in their final year of life."

Bingo! I checked with my doctor friend again and it is 95% in the last  
two weeks. (Actually he's not sure if it's two weeks or month but he's  
certain it is something short like that.) Nor do I see us, as a  
culture, losing the fear of death any time soon; nor will others stop  
exploiting it.

Sent from my iPhone

On Jul 28, 2009, at 1:38 AM, Dave <tiedye at turbonet.com> wrote:

> Fat cats cashing in on our fears.
>
> Dave
>
>
> Joe Campbell wrote:
>> I heard a statistic yesterday that we pay 95% of healthcare costs in
>> the last two years of our lives.
>>
>> Sent from my iPhone
>>
>> On Jul 27, 2009, at 11:08 PM, Ron Force <rforce2003 at yahoo.com
>> <mailto:rforce2003 at yahoo.com>> wrote:
>>
>>> Unfortunately, chronic disease accounts for most health care  
>>> spending:
>>>
>>> "What is surprising for many to learn is the degree to which the
>>> rapid growth in chronic illnesses such as diabetes, heart disease,
>>> cancer and arthritis, and related conditions such as obesity, are
>>> driving cost increases — and the implications this has for our
>>> national economy.
>>>
>>> Today, nearly half of Americans suffer from one or more chronic
>>> diseases, and treatment of chronically ill Americans accounts for
>>> more than 75 percent of our nation’s healthcare spending. In Med 
>>> icare
>>> and Medicaid, spending rates on the chronically ill are even higher:
>>> 96 percent and 83 percent of total spending, respectively."
>>> http://thehill.com/op-eds/chronic-diseases-overlooked--as-healthcare-cost-burden-2009-03-30.html
>>>
>>> Ron Force
>>> Moscow, ID USA
>>>
>>>
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