Tuesday, March 15, 2011

And Yet... Everybody Will Still Die

Paul Krugman correctly notes that we can't fix the budget problems created by Medicare and Medicaid simply by cutting spending.
Think of it this way: Congress could, with a stroke of a pen, cut Social Security benefits in half. But it couldn’t do the same with health spending: Medicare can’t suddenly start paying to replace only half a heart valve or mandate that bypass operations stop halfway through.

Limiting health costs, therefore, requires a smarter approach. We need to work harder on prevention, which can be much cheaper than a cure. We need to find innovative ways of managing health care. And, above all, we need to know what works and what doesn’t so that Medicare and Medicaid can say no to expensive procedures with little or no medical benefit. “So-called comparative effectiveness research” is central to any rational attempt to deal with America’s fiscal problems.
He correctly criticizes Mike Huckabee for attempting to perpetuate the tired old line about "death panels", particularly in relation to comparative effectiveness research. Huckabee's comments highlight a contradiction in the Republican stance on Medicare: they want to kill it, for example by replacing Medicare with a voucher system, never mind that you wouldn't be able to obtain meaningful insurance coverage with the voucher - but at the same time want to protect and even to expand it in order to curry favor with older Americans - hence their creation of unfunded drug benefits and prattle about "death panels".

But while Krugman is correct that we need to find ways to bend the cost curve, and that prevention and comparative effectiveness research may be the best way to achieve that, those measures will only go so far. Because we can delay the inevitable, but eventually a lot of us will end up in nursing homes and eventually every single one of us is going to die. The cost of that long-term care will for many people be largely picked up by Medicaid, and the high cost of end-of-life care by Medicare. The end of life counseling that the Republicans distorted into "death panels" might help with the cost of end-of-life care, but I'm skeptical that a significant number of people in our age- and death-phobic society will suddenly embrace the inevitable and eschew expensive treatments. Also, while it's easy to express shock at the extraordinary medical cost for the average person's last year of life, the fact remains that it's usually easier to tell when that "last year" begins in retrospect, and that while you may be able to get people to agree that they would be better served by living out their last year in home hospice care it may be quite another thing to convince them, "And you're already in your last year." Assuming we can accurately make that assessment.

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