POLICY: Becker-Posner miss the point

And in, I hope, the last comment on the Cutler piece, two venerable Univ of Chicago economists debate it on their blog, the Becker-Posner Blog

Posner ascribes the problem of the high cost of adding a year of life to an elderly person to the desire of people near the end of life to spend whatever it takes to stay alive. Other than that’s not how people at the end of their life usually feel, the problem with these rational analyses is that they don’t understand how health care works. Decisions about end of life care are not made by patients–they are made by doctors and health care organizations. Wennberg’s work clearly shows that. The enormous practice variation in end of life care is a factor of cultural variation amongst physicians not one of patient choice—the patient don’t know about it. And it applies whatever the insurance status of the individual because it’s ingrained in local medical cultures.Other countries have got their physicians somehow to accept that (for instance) heart surgery or kidney dialysis on a 95 year old with a life expectancy of 6 months is not good medical practice. Here we routinely do it (as in Posner’s father’s case).Stopping that absurdity is the solution to our health care crisis as that’s where the vast majority of the unnecessary spending is. But to do that we have to change medical culture, and rather more difficultly, health care system incomes!

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jdyvonne pennink Recent comment authors
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Yvonne, Do you know how much physicians make? They are generally in the top 5% of incomes in the US. How is it that someone earning $150,000 or $300,000 a year or more can’t “afford” to take on more Medicare patients? If a PCP earning $175,000 now would be earning $125,000 if they got paid the Medicare rate for everything, is that really a problem? If physicians leave medicine in droves because they can “only” earn $100,000 a year, what does that say about the motivations of people practicing medicine now? (For physicians who are angry at this comment, I… Read more »

yvonne pennink
yvonne pennink

I found the discussion about extending life interesting. I am 72, and at this age I need more and more healthcare, but I am functioning and participating in life. If I had a debilitating illness, or would no longer be able to actively participate in life, I would not wish my life to be extended at the expense of others. With Medicare that would be the case. In fact, every time I do go into the hospital I stipulate tht I would not want my life extended unless I can live of reasonable life. The Medicare reimbursements to physicians will… Read more »