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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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2 replies »

  1. 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 do think there needs to be a trade-off in terms of less paperwork and hassle, and also that med school needs to be better subsidized.)

  2. 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 be cut. Five (5%) cut going into effect, I believe, early in 2007 and then another whopping 33%, for a total of 40% over the next nine (9) years. Where I live doctors have already, some of them, dropped entire Medicare practices and most will not accept new Medicare patients. That will increase when the cuts go into effect. I know this as a patient. When I moved from a neighboring town to where I live now I had a heck of a time getting a primary care physician. Physicians in this area are also moved to neighboring states, or going out of practice altogether, because of relative high Malpractice Awards/Insurance Premiums. That is not a fact “cooked up” by the AMA. Patients run into those realities all the time. Even prestigious Medical Schools have physician (professors) shortages.
    We all have to become realistic. The first priority should be to keep people of working age working, and paying taxes and into Medicare, etc. That requires a system of Universal Healthcare, through private insurers, on a sliding scale and with government subsidies. It is still much cheaper than people not working, not paying taxes and getting transfer payments. And it is nice to be able to live longer, but sometimes one has lived long enough. Chronic pain, disease and inability to participate in life, coupled with advanced age, is not really living. I would like to be allowed to leave at such a stage, and with some of my dignity intact.

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