Medicare Debate is the Real Death Squad Issue

Categories: Schutze

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Reading about the Medicare debate and listening to friends and neighbors talk about it, I always come to the same conclusion: Your opinions depend entirely on your personal experiences.

A commenter here the other day said he thought most old people are "responsible" and have provided for their own medical needs privately. He said they are not "stupid" and know that Medicare is too thin a reed to depend on.

So I found myself immediately plunged into an area of thought and memory that I actually try to avoid whenever possible -- thinking about how extremely tough my own parents' last decade of life was before their deaths 10 years ago.

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My parents were the ultimate responsible middle-class Americans, products of the Depression, not just savers but scrimpers. I think by their late 20s, at an age when I was probably focused mainly on my next good vacation, they were already focused primarily on savings, pensions and insurance.

My dad was a clergyman. My mother was at home until her 40s, when she became a public school teacher to help send four kids to college. They retired with an excellent supplemental health care plan for life, which my mother always attributed entirely to her teachers' union, and with decent pensions from the Michigan teachers' fund and the Episcopal Church. They had substantial savings significantly enhanced by the high interest rates of the 1970s and '80s.

They were in their eighties. She went first. She was not the worrier of the two. My niece, a novelist, has written about my mother's quirky optimism, a twist on Middle Western Calvinism, I think.

My father worried profoundly. He literally hated any dollar amount greater than a hundred, no matter what it was for. Any bill or invoice that involved more than that was like a rattlesnake on his desk, not because he couldn't pay it -- he could always pay his bills -- but because it threatened in some primal irrational way the carefully tended and guarded confines of his private arrangements.

I went up to Presbyterian Village North to the tiny studio apartment he rented so he could be close to my mother when she was in the nursing wing, and I sat with him while he opened the bills for his own hospital stays, which involved heart problems, prostate cancer and a knee replacement.

He slits the envelope. Once fine fingers now twisted and bulbous with arthritis reach in shakily and extract the bill. He gasps, turns to me with eyes huge and round behind thick lenses and slowly extends the piece of paper for me to examine. It's a bill for $235,000. Then I do my speech, the one I came here to make, repeated so often that I fear by now it will sound canned and condescending, which will only piss him off enormously and give us even more problems to deal with.

"Dad, this is not a bill."

"Well it's not a birthday card, is it?"

I don't wonder where I got my own less than bubbly personality.

"Dad, this is an advisory of how much Medicare is going to pay. Medicare pays this."

"Medicare pays a quarter of a million dollars for a week in the hospital?"

"Yes."

"Well then Medicare is stupid."

He's angry. I can see the veins bulging on his forehead. The shake in the hand is faster. So far, not so good, Jim, with your mission of calm and healing.

"Dad, the doctors at the hospital are saving your life. Every time you go in there, you have a team of highly trained specialists gathered all around you, rooms and rooms full of high-tech equipment and brilliant people who could send a man to the moon. It can't be cheap. But if you insist on opening these bills and obsessing about the amounts, the bills are going to kill you."

"Maybe they should."

A life in the ministry had left him with a brutal sense of realism. He and I often talked about how the hospital was always full of old people whenever he went in. "Rooms and rooms of old people, hanging on," he said, "and you have to ask for what?"

We were not allowed to discuss his own reason for hanging on. It was off the table. Way too private, way too emotional. He hung on for seven years to be there for my mother, who was paralyzed by a stroke, to sit by her at every meal and then take up guard at her bedside to make sure she was properly tended.

He was not nice about it. Once when I was helping check my mother out of a rehab hospital, I filled out a sheet for one of the therapists and wrote down both of their names, starting with, "The Rev. W.R. Schutze." He was out of the room.

The therapist looked at it, whirled toward me and exclaimed in shock and disbelief, "He's a reverend?"

I said, "A mean reverend."

My mother nodded from her bed. "He thinks he has to be, for me."

The bottom line in all of this is that my parents, for all of their scrimping conservatism, would have died a decade earlier of their ailments had it not been for Medicare. Hell, for all I know it might have been 20 years earlier.

My father, because he was so ruthlessly pragmatic, would look at the Medicare question today and say it's a debate we need to have. He would say anything that costs more than $100 is a debate we need to have.

And he would have seen the stakes with brutal realism. He dealt with death all his life as a minister. There was nothing exotic about it for him. It was stuff that happened, like marriages and baptisms.

But he would have wanted the question debated honestly. He would have said, "This is a debate about whether or not the hospitals should be filled with old people, hanging on."

Take away or even seriously erode Medicare, and you're not just talking about poor old people dying for lack of care. The dollar amounts are way bigger than people who haven't been through it can even imagine. You're talking about smart, responsible, saving-and-scrimping old people dying because they don't have a few extra million bucks in cash lying around.

And those old people may not be simply hanging on out of some kind of stubborn selfish refusal to get out of the way for the rest of us. They may be staying alive so they can take care of some other old person nobody else is going to look after if they don't.

And anyway, when did it become society's right to give a big thumbs up or thumbs down on people's reasons for staying alive?

That's the real Medicare debate, the real death-squad issue. The Paul Ryan solution, to unmoor Medicare from the federal government, throw off the ropes and set it adrift among the vagaries of state politics, is the real death squad issue.

I'm glad my dad isn't here to see this, mainly because he might have agreed with Ryan, in spite of it being so diametrically opposed to his own interests. But I'm not glad my dad isn't here.

These are tough issues, because they are life and death issues. On the other hand, life and death are stuff that happens. And if it costs more than hundred bucks ...?

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49 comments
JM64
JM64

Reading through these comments, I get the impression that a few are realistic in accepting the practical limits of medical care administered to elderly people and/or those dying of terminal disease.

Others seem to be in the camp of 'preserve and extend life at all costs'.

 

I'm sure an actuary could present a concise breakdown of cost vs benefit of medical care applied to a statistical person of any age, but my gut feeling (and I apply this to myself) is that every person eventually arrives at a point in their life where their existence is not worth maintaining. If we were truly an enlightened society, we would have codified into law something similar to the 'assisted suicide' laws in Oregon and Washington state. Under those laws, people dying of incurable disease can be helped to end their life at a time of their choosing. I would much prefer that option to being forced to exist with very low or no quality of life. In my opinion, if I cannot enjoy living sufficiently to overcome the limitations brought on by aging and/or disease, I would prefer to be dead. I have taken some measures toward this 'end', having a 'living will' entered in my medical record and clearly making my wishes known to my spouse.

 

If everyone had this option, and we, collectively, could end the 'Christian' imperative to preserve life at all costs, the so-called 'end-of-life' medical costs would largely be self-limiting.

Guest
Guest

I can't believe these comments. We'd rather see our loved ones wanting to die or have them gone because of the high cost of healthcare than find a solution to make it more affordable. 

cheapoldgeezer
cheapoldgeezer

I would think that the $235,000 figure  is what the hospital billed medicare.  Medicare likely paid about 40% of that and the hospital was happy to get it.  Medicare also forwarded the balance to his other insurers if he had any who intern  discounted the balance and paid the hospital.  All this is crazy because of the tremendous markup hospitals charge medicare, medicaid,  private insurers and the general cash paying public.  What is really bad is that Obama dems sucked 716 billion out of the medicare trust fund. to finance Obamacare.  That  is money taken out of our paychecks just like social security which was by law intended to pay for health care for the elderly. I expect you will find lots more grandmas and grandpas driving themsellves over the cliff of their own volition in the near coming years because of the fact they don't have enough QLY (i.e. too old and to poor) to qualify for much more than a bottle of  Aleve. 

holmantx
holmantx topcommenter

Some years down the pike, we're going to get the real solution, which is going to be a combination of death panels and sales taxes. - your economic guru Paul Krugman

Myrna.Minkoff-Katz
Myrna.Minkoff-Katz topcommenter

What sort of fool believes that an older person will be able to go out and procure health insurance coverage with Ryan's vouchers?  What insurance company would sell a plan to an older person?  This is the reason Medicare was enacted in the late 1960's.

Dalguy
Dalguy

Jim, you asked:  "When did it become society's right to give a big thumbs up or thumbs down on people's reasons for staying alive?"  The obvious answer is when society started paying for it.

Myrna.Minkoff-Katz
Myrna.Minkoff-Katz topcommenter

The Romney-Ryan people have the same beliefs that HitIer did; that the vulnerable and the sick are expendable.

Joseph
Joseph

I think the solution to the Medicare dilemma will be to get rid of the preposterous inefficiencies of the way medicine is practiced overall in this country.  We need to get rid of incentives to perform procedures and incent medicine that keeps people healthy. We have only what can be expected with a system with the perverse incentive to bill by procedure.  There also need to be laws to force medicine to digitize records instead of repeating expensive lab tests and not having a record of what medications people are taking,  etc., etc,

 

The whole premise that insuring the elderly can (not to mention whether it should) be profitable is ridiculous beyond belief.  Does any one really believe the private sector can tack on another layer of bureaucracy, marketing costs, plus profit, and have cheaper, better medical care? Sheer adolescent, "Ayn Rand" fantasy. 

 

The Medicare problem is just part of the larger problem of inefficient health care. As a country we spend about twice as much as any other country on health care and what do we get?  The World Health Organization rates us at number 37 in the World in quality of health care. Among others, we are ranked lower than Colombia, Saudi Arabia, Chile and Costa RIca. Shameful.

 

I have lived in Japan, France, Britain, Italy, Germany and other countries.  I have never had to wait to get medical attention as long as in the US.  In Japan you can invariably just show up at a doctor's office or clinic without an appointment and be seen within a reasonable amount of time.  I don't know how they do it.  The horrible, hours long lines at American emergency rooms are unknown in other advanced countries.  

 

What the countries that outrank us all have in common is systems with a large dose of government control in the public/private mix.

Honeybee
Honeybee

Would love feedback on this:

 

I read or saw somewhere recently that the costs for Lasik and most plastic surgeries have gone down while quality has gone up bc you have pay out of your own pocket for these procedures.  

 

The argument being made was that it is precisely the existence of programs like Medicare that create the $250,000 bills for a week in the hospital.

 

So should the goal be to "save" Medicare as it is?  

Is it really smart to accept the shocking costs and waste bc we are afraid to try something different?

Care for people by all means, but can't we find a better way to do it?  This way doesn't seem so great.

 

JimSX
JimSX topcommenter

jddallas below tells us:" ryan is on record - on record, jim - that 'nothing would change for those older than 55.' But isn't this the ultimate "kicking the can down the road?" This kicks the moral/political can down the road, and that's the BIG can. 

What's scary, in fact, about Ryanism, is that he and his followers fade from view when we try to talk about the big can, which is, "Who needs to die?" Commenters below have suggested too many people are costing us too much money by hanging onto life too long.  So who are they? Do we have an absolute age cut-off? What is it? What age? Who lives, who dies?

If the Ryanites really had all this courage we keep hearing about, then we would hear them on this point. What frightens me about them is that they do want a cut-off point, but they lack the courage to come forward and say what it is or even to admit that they want one.

So how much do we trust people who want to make wholesale life and death decisions but don't want to admit that's what they're doing? Me, not much. 

jddallas
jddallas

Jim,

 

sorry for the loss of your dad.

 

in his 2008 roadmap ryan is on record - on record, jim - that "nothing would change for those older than 55." your dad would have been as just as appalled today as he was then. so this is not a paul ryan issue as it pertains to your family (or any other family involving seniors) issue.

 

you and i both know that the math doesn't work for the programs as they exist today. were we to take every last dime from the top ten percent of the wealthiest citizens - every last dime - the math doesn't work any better. then we'll take from the next ten percent. hmmmm, not enough help here. sooner or later it will be your ten percent, and mine, but we'll still have the problem.

 

allowing the states to experiment with solutions, as with massachusetts today, permits the best chance we have to do the best we can with the least amount of collateral damage. the recent institution of the massachusetts health policy commission diktats provides real world clarity for us. it is much less difficult for an citizen in oregon (or hawaii, heaven forbid) to march to the state capital, to wrestle with the state's varied interests, to "throw the bums out" than to do the same in D.C. besides, what are the "state exchanges" mandated by the ACA but adrift among the vagaries of state politics?

 

most citizens have not yet awakened to a fundamental truth of the ACA, which is that it is possible to mandate insurance coverage, but who will deliver the care? what good is auto insurance if the garages are all closed because they went broke fixing cars for less insurance money than it cost to do the repairs? sure, you have a voucher for a driver's door. good luck hangin' it on your car.

 

the states are our best hope, along with an honest debate (which you point out).

everlastingphelps
everlastingphelps topcommenter

"A commenter here the other day said he thought most old people are "responsible" and have provided for their own medical needs privately. He said they are not "stupid" and know that Medicare is too thin a reed to depend on."

 

I think you are talking about my comment, because I used those words, but that's not what I said.  I said that most old people aren't stupid, and they are responsible -- which is why the polls show that they support the moderate cuts in the Ryan plan (which are used to shore up the Trust Fund and help keep Medicare from completely collapsing in 10-15 years) as opposed to the Obama result, which was to strip even more money out of Medicare and dump into the Obamacare black hole.

 

The idea that Ryan is trying to destroy Medicare was rightfully declared the Lie of the Year 2011.  It's not what his plan did -- agree or disagree, his plan was to preserve Medicare (and add options.)  The Obama plan is to slowly strangle Medicare until it collapses into a heap.

morrainepeak
morrainepeak

I enjoyed your niece's  (Amy Shearn) article about your mother.  You need a little more of her "quirky optimism."

mavdog
mavdog topcommenter

Good piece Jim.

 

The question of death is easy when you're not faced with it. We can be so cavalier when we don't see the Grim Reaper right next to us, saying that we would welcome the exit if it were at our doorstep, that we don't want to be kept around just to be around.

 

But that isn't typically the case when it is truly the moment of dying. Most everyone hangs on, doing everything possible to not exit.

 

The costs are staggering. The truth is that neither the existing structure of Medicare, the changes brought on by the Affordable Care Act, or the untethering of Medicare as proposed by Ryan, will produce "Death Panels", because when it comes down to it nobody wants to set up a system that may tell them no when they want to hang on. So we'll just have to find a solution to how to pay these staggering costs to keep our old folks alive until the very end.

 

Interesting, I saw a piece recently on the Washington (state) assisted suicide situation:

http://www.nytimes.com/2012/08/12/health/policy/in-ill-doctor-a-surprise-reflection-of-who-picks-assisted-suicide.html?pagewanted=all

Wouldn't it be part of the solution to make this more acceptable by the public, and have the concept that an individual is doing themselves, and their loved ones, a positive thing by this action?

 

It certainly takes courage, but it many times is what is best.

MoeSchmoe
MoeSchmoe

It is a question of why our medical industrial complex focuses on the highest profit, cutting edge technologies that on one can afford instead of focusing on the most efficient delivery of less expensive procedures.

 

The next generations will ultimately be told by medicare "Geewhiz,  we don't have any money because we are still paying off debt that your great-great grandfather incurred 50 years ago to help prolong his life. We had to borrow back then because he was a voter and the people in power needed his vote to stay in power". 

 

So JimS is in fact kicking the can down the road to the defenseless souls who have not been born yet with his forlorn tales of service delivery that we should expect some TBD resource to provide for. 

JoeBlow
JoeBlow

"And anyway, when did it become society's right to give a big thumbs up or thumbs down on people's reasons for staying alive?"

 

I suppose it becomes society's right when society started paying for it (and I favor society paying for healthcare for everyone).  The fundamental question no one really wants to answer, so we don't ask, is whether we should be spending hundreds of thousands of dollars on each patient to buy a few extra weeks or months at the end of our lives. The federal government estimates that more than 50 percent of all health-care expenditures are spent on the elderly in the last month of life -- often for aggressive, life-sustaining care that is futile.     

scottindallas
scottindallas topcommenter

 @cheapoldgeezer That money is mostly taken from subsidies for medicare advantage plans, not medicare itself.  Why should the gov't be subsidizing superMedicare for those who can most afford it?  You want to control costs, but the one place where ACA/Obamacare does you whine.  That's the biggest problem is the most "entitled class" are our wealthier classes, and our baby boomers, the most coddled, spoiled, luckiest generation in all of history.  They sure didn't leave their kids anything but the carcass of what they enjoyed. 

JimSX
JimSX topcommenter

 @Dalguy Good answer to Part One. Now, Part Two, which people get a thumbs down, and when will you and Mr. Ryan be informing them? That''s the can you're kicking down the road. And just to make it more interesting, pretend that your own parents fall within the thumbs-down category. Would you be willing to handle telling them yourself, or does government have to do that for you?

scottindallas
scottindallas topcommenter

 @Honeybee plastic surgery and major medical care are different markets.  There perhaps ought to be some individual accountability, but when you go for a check up, and then find you're in need of immediate attention....

thefncrow
thefncrow

 @Honeybee Plastic surgery isn't something that's necessary to continue living.  As a result, it tends to be something more like other retail products, where a person has the option of shopping around and comparing prices.

 

Let's say you're having a night out on the town, something goes wrong, and your buddy has just been run over by a car.  Are you going to call 911, or are you going to start calling hospitals comparison shopping for the best deal, asking the operators "Hi, my buddy was just run over by a pickup truck, he looks like he's in really bad shape, how much will you charge to fix him?"

PlanoDave
PlanoDave

 @JimSX Jim, you are making too many assumptions.

 

It's not only "who dies, who lives".  Another choice is "how much money can we afford to spend?" and by answering that, we also have to address, why are we spending what we are spending.  That leads us to the "for profit" part of the equation.  Which is why I was so frustrated that Obama caved and dropped the public option from his plan.  If we can reduce costs, we can save more lives for longer.  If we can't reduce costs or reduce patients, eventually we will have to decide if the only function of government is Medicare.  That is the final end game of kicking the can down the road.  Frankly, at that point it will be moot because we will all be wearing those little commie hats and we won't be America anymore.

observist
observist topcommenter

 @jddallas You're talking about the math not working, but you seem to be grossly underestimating the amount of wealth the top 10% has.  The total net worth of US households is about $60 Trillion.  The top 5% has ~70% of the wealth, the top 1% has ~40%, or $24 Trillion.  The total annual healthcare expenditure is in the US is about $2 Trillion.  The top 1% could fund ALL US healthcare expenditures from investment income alone (assuming they get a return of 8.3%)

 

The problem is not as unsolvable as you seem to think - ALL of the other wealthy industrialized countries in the world have done a better job of providing healthcare to their population than we have, and all of them have less privatized, more socialized healthcare.

scottindallas
scottindallas topcommenter

 @jddallas a single payer makes the math work, in fact, we could cut the total cost of healthcare by 50%.  Consider that private healthcare has no interest in being the principle insurer for these people; and, they don't do squat compared to what medicare funds--that's when all the costs come.  Private insurance is subsidized this way, and too many of these firms treat us like rented cars anyway. 

thefncrow
thefncrow

 @jddallas in his 2008 roadmap ryan is on record - on record, jim - that "nothing would change for those older than 55."

 

This is a lie.  Medicare works as well as it does because it can negotiate below-market reimbursement rates because of the large pool of people insured under Medicare.  Once enrollment in that program halts, the pool of people insured under Medicare will begin to shrink and remove Medicare's leverage that keeps costs down as much as they are. 

 

The core functioning of Medicare requires a large pool of insured seniors.  Once the changeover happens and the pool of seniors insured by Medicare begins to shrink because no more users are being enrolled, you've got a limited number of options. 

 

1) You undo Ryan's plan and restore Medicare.

2) You raise provider reimbursement rates, making the program significantly more expensive.

3) You implement higher co-pays and cost-sharing to put the additional costs on the backs of the seniors enrolled.

4) You halt the Legacy Medicare program and move everyone to voucherized Medicare (which is not all that different from Option 3).

5) You do nothing and providers begin to stop accepting Medicare, leaving seniors with a decreasing number of options to receive necessary medical care.

observist
observist topcommenter

 @everlastingphelps  So after 100 posts saying how everything the government does besides defense is stupid, inefficient and corrupt, you're arguing in favor of the candidate who, by your estimation, will preserve Medicare longer over the candidate who will let it collapse?

observist
observist topcommenter

 @everlastingphelps You left out that the 2009 and 2010 lies of the year were Republican lies about healthcare:  "Death Panels" and "Government takeover of healthcare", respectively.

thefncrow
thefncrow

 @everlastingphelps Politifact's analysis is mind-numblingly bad.  Imagine you own a Mercedes.  Now, you decide to sell your Mercedes, but before you do, you rip the hood ornament off it and slap it on the Dodge Dart you bought to replace it.  Using the logic Politifact used, you would still have a Mercedes.

scottindallas
scottindallas topcommenter

 @mavdog my grandfather just got out of the hospital.  If he had his way, he'd be dead.  He had a very low pulse rate, and was put in the hospital, reluctantly.  They put a pacemaker in him, he and my aunt were under the impression that would do it.  It didn't and complications kept him suffering in the hospital, and wondering if he'd need a valve.  Well, thankfully, medicine seems to be able to make the valve passable.  (again, if he had his druthers, he'd be dead)  The optimistic and ignorant (as they can't know what else is wrong till they fix this heart rate) hoped this would do it.  He really needs a new valve, but was/is unwilling to go through the trouble.  (also, if the valve wasn't clearly the principle concern/problem, he wouldn't have qualified anyway)  He's 93, and until a few weeks ago was living on his own, and had few medical complications, other than treated prostate cancer a few years back.  His valve had kept him off the golf course for the previous 2 months.  But, the system, and the nature of the biz often lead to these procedures.  It wasn't he who wanted to go ahead, it was the inertia.

 

All my family has gone on their own terms (though my grandmother who died in hospice and greatly diminished from Alzheimer's might be an exception)  In each case, (my other two grandparents) the doctors wanted to do more, they had more done than they themselves wanted.  It's not just the people demanding this.

 

It's perhaps more like plumbing.  We know there's a leak, but we don't know if that's the only leak till we patch the one we know of.  After a couple of leak repairs, we would've been better off replacing the line, but we don't know that until we get in there...

scottindallas
scottindallas topcommenter

 @MoeSchmoe we blew that money to allow lower income tax rates.  $2.2 trillion was taken for that end. 

Double-O-Joe
Double-O-Joe

 @MoeSchmoe "why our medical industrial complex focuses on the highest profit"

 

Because hospitals are increasingly owned by publicly traded companies whose sole priority is raising shareholder value.  Medical care is subservient to the needs of the business, and the need of the business is profit. 

PlanoDave
PlanoDave

 @JoeBlow Or, on the other side of the same coin, should individuals, businesses and corporations be profiting hugely off society's desire to do the right thing by others.  That takes us down the road of "if the profit isn't there, why will the doctors provide this level of care?".  The answer to that probably gets us to the same point of "we simply can't afford to extend people's life the way we currently are."

Anon
Anon

 @thefncrow This is a really poor explanation, even if it sounds pleasing at first. The overwhelming majority of expenditures in healthcare are made with a patient's consent and supposed understanding. True emergency care in which there would be no ability to price shop due to the need to save a patient first, then ask questions, is a blip on the radar of health spending. Things like living wills so that family members understand the wishes of parents would go a long way towards getting rid of the wasteful spending at the end of life. And yes, it is literally a waste. Not just in my opinion. For anyone who has actually researched it, there is well-established economic research on the cost effectiveness of any and every procedure out there and the incremental benefit it provides to a person's life, based on how long they'd be expected to live and the condition in which they'd be living. Of course, everyone thinks his or her parent's life is worth an extra million dollars, even if it's just an extra week. That's because no one is asking them to pay it explicitly.

There are good explanations if you actually start asking questions instead of just throwing a blog post out about it. Drug companies market directly to consumers in the US (it's not allowed in many, many countries) so people self-diagnose. They get to the doctor convinced they need a certain drug, and to be honest, doctors know that if they tell the patient no, they will just go somewhere else. So they give in and write the scrip (I mean, unless there are dire side effects and they truly believe the patient has no need of the drug). 

A lot of the spending is simply based on the fact that fee for service is the name of the game in the US. Healthcare costs were actually being contained in the US with managed care in charge, but people got pissed because they couldn't go to the neurosurgeon for a sniffle and a headache that they were CONVINCED was some kind of brain tumor. We're a bunch of spoiled brats, expecting 21st century care on the budget of the 1950s when the solution to end of life care was a nurse to hold your hand, some morphine, and a shared hospital room. 

Honeybee
Honeybee

 @thefncrow Thanks!

Your reply makes perfect sense.

I'm interested to hear what your solutions would be; you seem to have a good grasp of it all.

everlastingphelps
everlastingphelps topcommenter

 @thefncrow More like, you have a Buick.  When it comes time to trade in the Buick, you can get a Buick like you always did, but you now also have the option to buy a Ford.  

 

And when a liberal gets a hold of that, they accuse you of trying to kill Buick.

morrainepeak
morrainepeak

You are correct that much, if not most ,of US  healthcare is, if not "consumer driven", then "consumer complicit". (The American public has different expectations compared to Canadians or Europeans).  Even in the face of statistics and medical literature reports of procedure "efficacy/inefficacy", you will find thse patients insisting upon certain procedures which are of dubious benefit.  Your point about "living wills' is excellent.  I do not personally believe that Medicare price controls on physicians (hospitals enjpy 3-100x the re-imbursement rates for the same procedure-- better lobbying, I guess), have done anything but escalate the problem.  A new complete overhaul of the system is needed.  If consumers were less incentivized to get every procedure known to man, it would help. (An excellent example of this is that in a bad economy health care spending has declined--WSJ).  There are Stark laws regarding physician self referral which have largely been circumvented by the "in-office: exception.

observist
observist topcommenter

 @everlastingphelps So it would seem that preventing civil war is yet another worthwhile government service.

thefncrow
thefncrow

I'd love to hear how Ryan's plan offers the ability to, as you put it, "buy another Buick".  Enrollment in the existing Medicare program will halt.  There will still be a government-option program that seniors can buy into, but even in the rosiest terms Ryan can offer, it's not "Give up your voucher and get into the same Medicare program we've always had".

scottindallas
scottindallas topcommenter

 @roo_ster I don't get a pay stub.  I get to pay 12% and 3.2%.  We all do, just most don't realize it. 

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