| May 26, 2006
Striking numbers. Also, the top 5 percent of the population accounted for 49 percent of health care expenditures.
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Make futile measures an out-of-pocket expense, and you will see a significant reduction in health care spending.
Yes, but who gets to decide what is futile?
Democrats want to take from the rich and give to the poor. Likewise, they should be willing to take from this top 5% to provide health insurance for the uninsured.
I could easily decide what is futile, but then plaintiffs and lawyers would accuse me of playing God, and I would get sued and the remaining 95% of people indirectly duffer for it.
“Yes, but who gets to decide what is futile?”
How does medicare decide what it will pay for and what it won’t ? How does BCBS decide when a patient needs an MRI and when it does not ?Just follow evidence-based medicine and you can find the guidelines.
#1 Any system that will not treat premature babies will be very unpopular. Of course it would be compared to fascist regimes and other horrors of history
#2 Somewhere along the American started thinking dying was optional. How many people really want to die in an ICU while the staff are “doing everything?” But that’s what we do every day all over the country.
And for all those thinking that a one-payor system is the end-all answer, just remember the “R” word…
Of course that number is “striking.” That is exactly why that particular statistic was selected – to give an impression that there some health consumres are overusers who are ruining it for everyone else. But is that what the number really means?
First, it is a meaningless statistic all by itself. 22% of resources going to the sickest 1% could represent a normal distribution of sickness. Or it could mean that the vast majority of people are very healthy (lucky for them!). Or it could mean that the a large majority of people don’t have access to health care at all, thus less money is spent on them.
Second, the article doesn’t even say who is paying that 22%. You can’t jump to the conclusion that it is government spending. It doesn’t say what portion is coming directly out of pocket from the 1% themselves, or how much of that figure comes from private insurance premiums or what.
Third, you have to ask, compared to what? For example, what percentage of payouts of automobile insurance claims is going to what percentage of subscribers? You pay your car insurance premiums knowing, or rather hoping, that you won’t “come out ahead”; that is, that you won’t get into a wreck. That is the idea of spreading risk – being willing to pay more in than you will probably get out, in exchange for some certainty that you won’t be wiped out if the unthinkable should happen. Does 22% of insurance claims being paid out to 1% of subscribers sound excessive to you? 100% perhaps yes, but 22%? You have to put these numbers in perspective.
I think all professionals should be required to pass a basic statistics course in order to receive a college degree. Not being able to critically analyze claims and the often self-serving statistics used to support them makes us vulnerable and manipulable, both individually and as a society.
Last, a few thoughts on how we should view the healthy vs the sick in our society. Health as a personal responsibility is an appealing idea from a libertarian point of view, but in reality, there are a lot of factors that individuals can’t control, like genetics, exposure to environmental contaminants, poverty, and various social factors like access to wholesome foods and safe places to exercise. The idea that everyone should just pay for what they use means that each individual is born into a horrible game of russian roulette, where if they have a health crisis, only their wealth will determine whether they can get well and whether they will be financially ruined in the process. To all you “cry me a river, life ain’t fair” people out there, I hope you agree that there is still such a thing as justice. Though life may not be fair, that doesn’t mean we shoudn’t strive for a just society.
I didn’t mean to make it sound like I am attacking Kevin MD’s critical analysis skills – I assume you would need a fairly solid set of math skills to get through medical school. My comment about having competence with statistics was more directed toward professional journalists who uncritically pass on these figures to the public, and secondarily, to professionals of all types as they are typically in more influential roles in society.
Kevin never said the govt was paying the 22%.
22% does seem excessive. What number do you think an ecceptable number is?
If we could keep some person alive with a trillion dollars a year should society do it? At what cut off is the individual a detriment to population. Where is that line drawn. Those of us who practice medicine see futile medicine daily because of societies unrealistic expectations.
Will the car insurer keep fixing your car if you keep pounding it with a hammer repeatedly? In medicine people are being pounded with the hammer.
This survey done by the Federal government is for the entire US population of 288 million. Which means it includes the 46 million Americans without health insurance, as well as those with government-paid insurance and those with private insurance. It would be interesting to know, for that 1% who consume 22% of all health care dollars, what their insurance status is.
My guess for the 1%-very premature babies-ESRD on dialysis with CAD/PVD
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