48 thoughts on “Ahead Of Her Time”

  1. The lefties won’t feel the pain because they won’t see the truth right now. Even in the evidence of this “pay to disseminate information”, nor Ezekiel Emanuel’s comments about the societal worth of the patients and rationing; nor the government “suggestions” that maybe mammograms can wait until your 50’s, or Obama’s comment that the government will decide whether the red or blue pill will work best for you. They will view it as the article suggests;

    “On no no no, tut tut, we are merely dispensing information. Making all options known and understood by the dear patient.”

  2. I’ve noticed that Obama seems to prefer a government of edicts rather than a government of laws … as long as he and his like-minded “progressives” are the ones who issue the edicts.

    When citizens are controlled by edicts, it’s so convenient to issue exemptions to people you like, and to strictly enforce the edicts when you want to punish or persecute people you don’t like.

  3. Where is the evidence for death panels?

    the doc trying to bill medicare is whose agent: the gov’t or the patient?

  4. Oh yes, and then there was Dr. Donald Berwick, Obama’s director of the Center for Medicare and Medicaid Services:

    “It’s not a question of whether we will ration care, it is whether we will ration with our eyes open.”

  5. A lot of folks seem to be terrified of Sarah Palin as POTUS, even some of my closer friends whose opinions usually are fairly well grounded, but I cannot get anyone to articulate a serious objection that is valid. By valid I mean stuff like “she has no executive experience” when such a remark applies to a much greater extent to Obama, “she quit as Alaska’s governor” when legal defenses were bleeding her dry personally.

    What gives? She seems really smart, her political achievements in Alaska appear genuine, and she also appears to have surrounded herself to date with smart and loyal people. I think we are long overdue for a savvy politician to put some sunlight on Washington and scrape out a lot of the bloat and rot.

  6. Just advice, and participation is “voluntary.” If so, why do you need a panel at all? People have been making end-of-life decisions on their own for decades without govt ‘advice.” Plus, in all the debates about what type of health care system the USA should have, has anybody considered the S. Korean health system. The govt pays 50% and you pay 50%. The govt takes about $50 a month out of your salary, and many people have a supplementary private health insurance policy (like we do) on the side. A strong private medical sector seems to exist in a symbiotic relationship with the govt. Our residence is flanked by a private dental clinic on one side and a private ENT clinic on the other, not to mention the fact that there are numerous private skin and cosmetic surgery clinics. The ENT next door is able to send his kids to college in Canada. You have to wait in the big hospitals, but I’ve never had to wait more than an hour. Not perfect, but the system does seem to provide some medical coverage to just about everybody without breaking the bank.

  7. “On no no no, tut tut, we are merely dispensing information. Making all options known and understood by the dear patient.”

    It’s exactly the sort of “imbalance of power” that Lefties wage wars against when in furthers their cause, no?

    And let’s not forget that notorious Teabagger Paul Krugman calling for Death Panels.

    What gives?

    She knows the emperor is naked and is unafraid of telling everyone. For the Left, there is no greater sin. Carthago delenda est!

  8. We have seen how unrestricted regulation destroys companies and jobs, so why shouldn’t they start working on life itself? The regulators don’t care. It’s not their companies or businesses or lives. They answer to no one. As far as I have witnessed, they love destruction and the leveling of all people to the same gray mud the regulators come from.
    I certainly hope this new congress will start to put the regulators out of existence. Regulate the regulators until they’re gone.

  9. Robin would probably argue now that death panels will inject some long-overdue rationality into our cargo-cult thinking about medicine.

    thanks for your mind reading talents!

  10. ___________________________
    Jiminator Says:
    December 26th, 2010 at 4:48 pm

    A lot of folks seem to be terrified of Sarah Palin as POTUS, even some of my closer friends whose opinions usually are fairly well grounded, but I cannot get anyone to articulate a serious objection that is valid. By valid I mean stuff like “she has no executive experience” when such a remark applies to a much greater extent to Obama, “she quit as Alaska’s governor” when legal defenses were bleeding her dry personally.

    What gives?

    _____

    Easy: Shes a woman, a redneck, was not born to rule and shock, horrors, never went to a prestigious university.

  11. (f$#@* I submitted before completion, please ignore my previous post)
    _________________________
    Jiminator Says:
    December 26th, 2010 at 4:48 pm

    A lot of folks seem to be terrified of Sarah Palin as POTUS, even some of my closer friends whose opinions usually are fairly well grounded, but I cannot get anyone to articulate a serious objection that is valid. By valid I mean stuff like “she has no executive experience” when such a remark applies to a much greater extent to Obama, “she quit as Alaska’s governor” when legal defenses were bleeding her dry personally.

    What gives?

    _____

    Easy: Shes a woman, a redneck, was not born to rule and shock, horrors, never went to a prestigious university. I’m convinced she is dismissed by many due to snobbery and misogyny. I hope she does run for POTUS. Maybe, just maybe, she will be given the chance to be judged on her own merits or lack there off.

    Ralph

    PS . Redneck simply refers to people who have a “red Neck” from sunburn. Outdoor workers like painters, farmers and of course fisher women. A perfectly respectable term.

  12. Ralph, you can add that Palin goes hunting with large firearms. And she is the strong woman the feminist movement claims to support, not the victim of gender that leftist feminists really want.

    Other than the gender, which I really don’t care about, that’s all points I see generally in her favor.

  13. “she quit as Alaska’s governor” when legal defenses were bleeding her dry personally.

    This is what bothers me. I guess I don’t buy the excuse without some numbers to back her up. No offense to Palin, but this looked like a fight she should have been able to win.

  14. “No offense to Palin, but this looked like a fight she should have been able to win.”

    Maybe the victory would have been Pyrrhic. Being sidetracked by all the legal action might have caused her to do a lousy job as Governor. And thast might have hurt her more than the negative of quitting. Who is to say? She made her choice and had her reasons. Time will tell if it was the right choice. I don’t have enough info to know.

  15. I guess I don’t buy the excuse without some numbers to back her up. No offense to Palin, but this looked like a fight she should have been able to win.

    too stupid by far. bing is your friend.

  16. “Where is the evidence for death panels? ”

    All through the presidential election and right up until today, the lefties, and their media cohorts, constantly tell us to ignore what we SEE; what is right before our eyes; the evidence that piles up and points to reasonable conclusions; reasonable predictions.

    Ignore the fact that Obama had no real experience; dodged a huge amount of tough votes with “present”; hides his grades; launched very little serious legislation anywhere; said absolutely nothing in most of his speeches; uses facade rather than performance to justify why one should vote for him.

    And after nomination, had a bizarre notion of self-preening like Greek columns at his nomination acceptance and after election there was the ridiculous “Office of the President-elect” placard; said he was going to show us how dedicated he was to cost cutting by demanding his staff cut to the bone and they found a laughable $121 million. Screams at Mach 1 to sign the Guantanamo closing and has to ask around if, at the signing, right on tv, if we actually have a plan for implementation. Each of the 2 years he’s been in office he promised to focus laser-like on the economy – and didn’t. All show. Big words no serious results.

    It goes on and on and on. A huge and ever growing history of evidence that words and actions do not match and that the actions – past and present – should NOT be ignored.

    Yet we are told to do so.

    We have his words declaring to SEIU he is dedicated to a single payer system, and surrounded himself with like minded people who say the same thing. He claims we can keep our insurance plan yet a moment’s thought shows how that will not be possible. His appointees openly declare for rationing yet we are told to ignore it: there will be no rationing.

    Well sorry, some of us believe what we see, not what they say.

  17. Cancer has filled the government. A good person like Sarah alone could only scratch the surface. As someone has pointed out here before, it used to take a constitutional amendment to do the things they do now by edict alone.

    Those in power still don’t get it, regardless of party. It is not clear how it will end.

  18. Easy: Shes a woman, a redneck, was not born to rule and shock, horrors, never went to a prestigious university.

    And she’s not a lawyer. Can’t have that.

  19. There’s also a discussion of this topic underway at the Market Ticker.

    Basically, most of the average person’s lifetime health care expenses are incurred in the last few months of life, and we simply do not have the money to give each and every person state-of-the-art care. If the government takes over, there will be rationing. It cannot be otherwise.

    The solution, as in most things, is less government regulation and interference, and less cost-shifting by third-party payments. Make everybody responsible for their own routine checkups and preventative care.

    Legalize the reimportation of drugs and medical devices from other countries. Currently the pharmaceutical companies make deals with socialist foreign governments for volume purchases. This means that Americans largely shoulder the burden of research and development costs through higher prices. With reimportation, the drug companies will have to start charging foreigners more realistic prices, which will reduce prices for Americans.

    Free-market competition will drive down the cost of more expensive procedures. The health care industry needs more free-market competition, not less.

    (And check out my current signature. I’m on page 3 of the comments.)

  20. too stupid by far. bing is your friend.

    I see a number of excuses there. What makes your pick the right one?

  21. Hmmm…

    The Times says that the government “will now pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.”

    Sounds more like a “Death kickback”

  22. Alaska state law requires the Governor to foot the legal bills personally. At the time she resigned, that was $500k.

  23. Let me elaborate. I read that Palin had accumulated half a million in legal bills by the middle of 2009 with a number of the investigations started before she became vice president material. However, no other governor of Alaska seems to have had this sort of expensive legal difficulty. Maybe if I were in her shoes, I’d resign too, but I’m dubious that I’d have accumulated legal bills that large.

    To be blunt, there seems to be two categories of legal problems, a bunch of FOIA requests (at least 150) and more than a dozen investigations and lawsuits. Much of this seems to be “owned goals”, that is, legal vulnerabilities created by Palin herself. For example, she used private email to conduct some public business. And it appears that Palin attempted to use her office to settle private grievances in a legal but morally questionable manner (“troopergate”).

    I recognize that she was subject to a tremendous, one-sided, and unfair assault in 2008, but I do see problems underlying her governorship. To be blunt, her actions still do not make sense to me. I’m sure everyone has run into people that are always getting into bizarre trouble and legal difficulties. When I hear such tales (entertaining as they might be), I always wonder what’s the real story? Most people, even controversial, high profile politicians, get by without generating a huge number of lawsuits and such things.

  24. what’s the real story?

    You can read it yourself; chapter 5 of her first book. Probably take a half-hour at a local B&N.

  25. We have a limited number of dollars to spend on health care and not enough to “do everything,” as so many patients’ families insist. Whether it’s the free market doing it or the government via Medicare/Medicaid, there is and there will be “rationing” going on.

    Making it possible for doctors who take Medicare to charge for palliative care consulting is not this great evil some people are making it out to be. It’s a serious discussion that needs to take place and doctors at public hospitals don’t get paid if there isn’t a charge code for their time.

    Studies have shown that people that are educated on the cost-benefit analysis of palliative care vs. “full code” largely tend towards palliative care, which is often cheaper and enables more people to spend their last days with their loved ones.

    I’m wholeheartedly in favor of opening up our healthcare system to a truly free market and breaking the unholy alliance between government and corporations that keeps consumers uninformed and out-of-the-loop. This is a common-sense proposal that stands a real chance at helping lower systemwide costs until we can get more widespread reform, though.

    Sarah Palin doesn’t know what she’s talking about on this particular issue.

  26. G’day,

    Karl, No other Alaskan governor was ever a Republican VP candidate. No other Alaskan governor was ever a threat to the One. All those ethnic complaints were dismissed. They had no substance.

    Here resignation not only prevented her family’s bankruptcy but benefited the people of Alaska by not having their Governors time wasted fighting the complaints.

    Note: the law has now been changed to prevent such attacks:

    http://www.juneauempire.com/stories/120810/reg_751695390.shtml

    The fact that the laws had to changed recognize how the original law was abused to try to destroy her.

    ta

    Ralph

  27. Justin Kugler Says:

    “Making it possible for doctors who take Medicare to charge for palliative care consulting is not this great evil some people are making it out to be. It’s a serious discussion that needs to take place and doctors at public hospitals don’t get paid if there isn’t a charge code for their time.”

    Well let’s see – just off the top of my head:

    1) Why do you assume the conversations AREN’T taking place in sufficient numbers? You (and the government) must be assuming that, otherwise you wouldn’t offer the incentive to have the discussion. Just how do you come to this conclusion?

    How many do give that advice? How many don’t? How do you conclude that not enough doctors give the advice? All you have is the evidence that patients hold out til the last and spend the money.

    But maybe that was the patient’s decision.

    2) Where do you get the right to take my money and pay doctors to give certain advice? Doesn’t matter what the advice is. Just who do you think you are, that you can simply decide take money from taxpayers so that you can pay doctors to give advice which, for all you know, they already do?

    a la Bastiat: What about the fact that taxpayers no longer have that money to spend for..oh gee I don’t know, health insurance?

    Maybe worse is if they don’t raise taxes to pay for this idea but borrow the money thereby inflating the currency further.

    3) How will the doctor report that the advice had been given? paperwork? MORE paperwork? That will raise the cost of health care. (See #2: Bastiat)

    4) How will you assure that doctors are not faking the answer? How do you know they are not filling out the paperwork saying they gave the advice just to get the cash, when in fact they did no such thing?

    After all, this is the same President who accuse doctors of yanking out tonsils or hacking off limbs for no good reason other than they needed to make another payment on the Ferrari.

    So how will you check to see there is no fraud going on here? There’s only one way:

    Hire people to check. Oh dear up goes the cost of health care (see #2) all just so that the government can stick their noses into the health care tent.

    5) Suppose we do what you think is innocent. What if government decided to take the next step:

    Reward a doctor financially for prescribing painkillers and telling the patient to go home and die? Would you be fine with that? (See #2,3 and 4) It’s not FORCING the doctor to do it.

    6) When you take the Government’s coin, you are then required to do what the government says: see GM takeover, and the financial firm takeovers.

    7) You wrote:

    “I’m wholeheartedly in favor of opening up our healthcare system to a truly free market and breaking the unholy alliance between government and corporations that keeps consumers uninformed and out-of-the-loop.

    So why do you want to give the government more power and control? (see #6)

    8) If it’s such a great money saver, why don’t insurance companies pay doctors to give these lectures?

    9) You wrote:

    “This is a common-sense proposal that stands a real chance at helping lower systemwide costs until we can get more widespread reform, though.”

    It is a silly and dangerous idea that common sense says will leads to higher cost health care, a source of fraud, and bloated government bureaucracy at the least, to DC based bureaucratically decided death panels at the worst.

  28. Redneck simply refers to people who have a “red Neck” from sunburn.

    No, it doesn’t. “Redneck” is a reference to someone of Scots-Irish descent. It came from England in the seventeenth century (when many of the emigrated here from there), and referred to the red collars that many Presbyterians in the north of England wore.

  29. Oh and #10:

    10) How warm and fuzzy does it make you feel that this new rule was arrived at not by legislation/votes but by fiat. How do you like this mechanism being used to make decisions about your life? Orders of some bureaucrats (not legislators who must stand for election) sitting on their duffs in DC? No debate; just make up the rules.

    What stops them from going further? (Se #5,6,7)

  30. It only applies to the existing Medicare system, Gregg. Did you read the NY Times article Bob linked to? This has nothing to do with private insurance.

    In the existing Medicare system, if a doctor can’t charge for a consult or procedure and it’s not covered under EMTALA, it’s highly discouraged. I know of doctors who were fired for ordering too many consults that couldn’t be justifiably charged. The current system is heavily skewed towards specialized procedures and intervention, not preventative care.

    This measure allows doctors to include palliative care consultations and end-of-life planning in the annual wellness exam for Medicare patients, since the measure to allow such consultations their own charge code every five years was shot down thanks to hysteria like that from Palin.

    Most of the questions you raise are general to Medicare, not specific to this issue, so I really don’t see them as germane. If Medicare money is involved, it’s not just up to the patient how the money gets spent, as you rightly recognized. If you don’t want the government involved, don’t take Medicare funds.

    This does not give the government any more power or control than it already has and gives doctors and patients under Medicare more options. Given that studies have shown patients and families that are better educated on the available options and likely outcomes tend to be less likely to choose end-of-life intervention that is often much more costly than palliative care, I think this could help reduce costs in the long run.

  31. As for #10, regulatory agencies do it all the time under the power delegated to them by Congress. Congressional oversight panels are the mechanism we have to keep them in check.

  32. Justin Kugler Says:

    “It only applies to the existing Medicare system,”

    Nose in the tent. If they drive the system towards single payer (as is the plan), then that rule will be nicely in place for the system *you* are forced to use. And again how do you know they are NOT getting that advice in sufficient numbers? And all the rest….

    “As for #10, regulatory agencies do it all the time under the power delegated to them by Congress. Congressional oversight panels are the mechanism we have to keep them in check.”

    In a 2000 page bill which no one has read and which has (I paraphrase) “…the such and such agency will write the rules at a later date” just how many rules do you think might evolve from this? 1000? 10,000?

  33. I think it’s pretty obvious when studies show the efficacy of education and so much of our health care costs are still at the end of life and, according to the CATO link above, ultimately ineffective, Gregg.

    As a taxpayer, why should I have to pay for someone else’s exorbitant end-of-life procedures that could have been avoided if they and their family had been better educated on the options and outcomes? If they want the doctors to “do everything,” they can pay for it with their private insurance or out of their own pocket. As long as the government is spending my money on Medicare, I want them getting the most efficacy for my dollar.

    Even so, I wouldn’t have a problem with my private insurance covering palliative care consulting and end-of-life counseling. My wife, who is an internal medicine resident and sees first-hand the waste in how our society doesn’t deal with death rationally, and I have both agreed that we don’t want to put unnecessary burdens on other people and would rather have palliative care if the doctors are certain further treatment is futile.

  34. “As long as the government is spending my money on Medicare, I want them getting the most efficacy for my dollar.”

    Didn’t the British go from consults to denial of treatment? I think so.

  35. Their system seems to work well enough that the Economist Intelligence Unit rated it the best in the world for end-of-life care, despite its problems.

    http://www.eiu.com/site_info.asp?info_name=qualityofdeath_lienfoundation&page=noads&rf=0

    The US was noted for its attitudes that palliative care ran counter to religious sentiment and is akin to “giving up.” Our basic environment, quality, and availability were rated high, but our costs were among the worst in developed nations because of our focus on intervention over palliative care. They cite a 2006 study in Spain that found 61% savings when practices shifted from more conventional hospital treatment to increased use of palliative and home care.

    If we’re really interested in reducing the size and cost of government, getting savings like that with Medicare sure would be a good start.

  36. I recognize that she was subject to a tremendous, one-sided, and unfair assault in 2008

    Do you really Karl? Then how is it you do not seem to recognize she made a decision that had the effect of defanging the assault? If you do realize, why can you not support her decision and also realize she has made fools of those that said she was done politically?

  37. Justin Kugler Says:

    “I think it’s pretty obvious when studies show the efficacy of education and so much of our health care costs are still at the end of life and, according to the CATO link above, ultimately ineffective, Gregg. ”

    You know nothing of the sort. For all you know, people got the talk and rejected the idea in favor of fighting to the last. You do know that a lot of money is spent on end of life care. Let Spain kill them off if they want to.

    You cannot erase a trait in one aspect of a personality and expect that loss not to affect others. It’s the governmental re-shaping of attitudes that is MOST insidious about all of this.

    “As a taxpayer, why should I have to pay for someone else’s exorbitant end-of-life procedures that could have been avoided if they and their family had been better educated on the options and outcomes?”

    If government was not in the health insurance business and therefore the health decision business, you wouldn’t have to pay a dime. This is much more a far reaching issue that your laser-like focus on Medicare/aid. That’s one reason why I posed those 10 items above: yes I knew the article was on Medicare/(and also by government connection, Medicaid). Those questions are keenly relevant to the NYT article. It’s important to assess the secondary effects of government action – like how it costs taxpayers of all kinds money – money which they would use more intelligently. It matters that you open the door to certainly more paperwork and definitely more fraud and therefore more costs in fraud police etc etc.

    ” Even so, I wouldn’t have a problem with my private insurance covering palliative care consulting and end-of-life counseling.”

    But they don’t. Why do you think that is?

    “My wife, who is an internal medicine resident and sees first-hand the waste in how our society doesn’t deal with death rationally, and I have both agreed that we don’t want to put unnecessary burdens on other people and would rather have palliative care if the doctors are certain further treatment is futile.”

    Fine, that is your choice. Isn’t it nice that you GET the choice? And isn’t it nice that you can change your mind?

    And here’s a #11 for you:

    It so happens that what today’s government wants matches your choice. So their decree is no problem to you. Suppose a new government gets voted in who is adamantly opposed to this, and *in the exact same way – by decree not legislation for which they are held responsible* you are no longer able to choose your way but are FORCED to stick it out with “heroic” treatment to the end. How would you like that?

    This can happen once you give government the power to make those decisions for you.

  38. As a taxpayer, why should I have to pay for someone else’s exorbitant end-of-life procedures that could have been avoided if they and their family had been better educated on the options and outcomes?

    You’re right, but you are missing the bigger point. Why are you, a taxpayer, having any say in someone else’s personal decision?

    Here’s an idea; get your taxdollars out of the business of telling me and my doctor what to do.

  39. Pattern recognition test:

    2009: “There are NO death panels!”
    2010: “The death panels are here, but palliative care is NOT mandatory.”
    2011: ???

  40. I’m not missing the point, Leland. I already said I am in favor of market-based healthcare reform. I think the CATO Institute has the best comprehensive plan I’ve seen yet. However, I already am paying for other people’s healthcare. Given that reality, I think some reform is better than no reform.

    The fact of the matter is that the government is already up to its neck in the healthcare system. As long as that remains the case, we taxpayers should be demanding they get the best value for our dollar. That means following evidence-based medicine and limiting how much the government spends. Or do you think that the best way to get the government out is to just bankrupt the system and deal with the cascading effects afterwards?

    The available evidence shows that patients educated on the risk-benefit analysis of palliative care versus full intervention tend to choose palliative care. The available evidence shows that patients who choose palliative care suffer less and cost the system less. Increasing education about palliative care in the Medicare system is, thus, likely to reduce costs over time because fewer people are likely to choose full intervention.

    This should be a no-brainer for a fiscal conservative.

    Gregg, I don’t think your assumptions that increased palliative care would lead to increased paperwork and fraud above and beyond the savings over full intervention have any merit. That’s not the case where it’s actually been implemented.

    And, actually, most private insurance plans do cover palliative care because of its benefits, including mine. 🙂

    If you don’t want the government making decisions about your healthcare, don’t take taxpayer dollars.

  41. I can assure you that people on Medicare already discuss end of life decisions with their doctors. Doctors and patients discuss many issues during a visit, not only those that have a code that they use to charge the government with.

    The issue isn’t the current end of life discussions but is that people in favor of rationing care don’t like the outcomes of those discussions. Why is it surprising that people would want to be resuscitated or that people continue taking cancer or heart meds well into their 90’s?

    The high cost of end of life care isn’t just from procedures or medicines, it is because the patient needs constant attention from a human being. Assisted living and hospice are very expensive. I don’t know how Obamacare lowers those costs. IIRC there are provisions that actually increase the costs of assisted living.

    Being on Medicare and in assisted living is a horrible experience. While that safety net might a good thing for some people, we should not have a system with the intent and design to have everyone in that position.

    As was already stated, when you get money from the government there are strings attached. Doctors being required and restricted to only talk to a patient about government approved end of life options isn’t something I’m looking forward to.

    I think a lot of the young people in favor of this stuff will change their minds when they are older.

  42. If you don’t want the government making decisions about your healthcare, don’t take taxpayer dollars.

    That would only work if we could opt-out of Medicare and Social Security contributions.

    See, the thing is — you actually can’t opt-out of Medicare because you’re automatically enrolled once you start taking SS retirement payments, and if you’re on Medicare, doctors must bill the government. For those over 65, the government has long-since taken over the medical industry, so your “deal” is naive at best.

  43. I’m well aware of that, Titus. I was simply pointing out the incongruity of complaining about a preventative measure that stands a chance at reducing system costs just because it means the government is making a decision at all.

  44. Justin,

    I’m apologize for not reading your entire point. Honestly, I saw the snippet from Gregg, and that motivated me to respond. I sense you are being straight forward about the implications of the issue rather than advocating the points. Indeed, if the government must have a role (because the majority of us sovereign think it should), then there are cost savings to the taxpayer by having decision on how much care is given be decided in advance. Really, that’s the majority of how government involvement changes the costs.

    The reason healthcare costs are higher in the last few months/years of life is simply because that’s when it is of greater value to the individual. As long as the individual has control of the value, that will almost always hold true. The belief is that communal interest will shift the value of healthcare to an earlier period and more uniformly distribute the spending. I say belief, because I’ve never seen any evidence that it will actually happen. Even where universal healthcare exists; unless you mandate routine checkups, people will still only seek care on a need basis. Most of that need will always be when a person is already sick or dying.

    Personally, I don’t see the spending near death to be the waste in healthcare. If anything, what we spend in trying to prolonge life at the late stages brings knowledge that has continued to extend the life expectancy of all of us. I see the waste in people who see the money in the system and try to cash in on it. The abuse can be freeloaders that abuse free emergency care, pharmaceutical companies pushing ineffective drugs, or lawsuits against good doctors who couldn’t do anymore to save a life or a limb. In any of those cases, there seems less desire to reduce that abuse than there is to create new avenues to abuse the system.

  45. No worries, Leland. I appreciate you taking the time to reconsider my argument. Yes, I would prefer that we have a truly open and free healthcare market, but I’ll take a reduction in government costs, for now, if we can get it.

    As for the cost of end-of-life care, I don’t agree with that interpretation. It’s not about shifting the value to an earlier period in life. Palliative care is about increasing the comfort of the patient, the quality of the time they have with their loved ones, and avoiding expensive interventional treatments and procedures that medical studies indicate aren’t actually doing all that much for us.

    The available data repeatedly shows that Americans spend more on end-of-life care than any other developed country and our outcomes are not better for it. While I agree that we should tackle the problems of freeloaders, pharm company fraud, and the broken medical malpractice system, this is still a big part of the problem.

    Medicare spent $55 billion on bills for the last two months of patients’ lives last year. That’s more than the DHS budget. I think the following article is a really good summary of the issue.

    http://www.cbsnews.com/stories/2010/08/05/60minutes/main6747002.shtml

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