5 ms·

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is b

by anjc 4y ago

> the next time you have trouble booking a surgeon or even a gastroenterologist, you can remember that America’s supply of surgeons and gastroenterologists is being disproportionately used by the AARP crowd. What a horrible sentiment.

questime 4y ago
Because of demographics this is a problem we will have to confront regardless - do you think medicare/medicaid spending will become 80% of government spending?
- virgildotcodes 4y ago
  Maybe with higher taxes and a reallocation of defense spending we’d be able to sustain a more humane society for longer. Is it indefinitely sustainable? Not sure. I don’t know if it’s as easy as just extrapolating from recent trends because there may be countless unknowns from biomedical advances to climate destabilized societies to being turned into biological batteries for our machine overlords in the next few centuries.
  - ch4s3 4y ago
    Having medicare operate under a fee for service model will never be sustainable in the long run. We already spend $ 755 B on Medicare, which is roughly equivalent to the DoD's $ 767 B, and Medicare is notoriously wasteful[1][2]. [1] https://www.healthaffairs.org/do/10.1377/hpb20220506.432025/ https://www.healthaffairs.org/do/10.1377/hpb20220506.432025/ [2] https://vbidcenter.org/wp-content/uploads/2021/10/jama_shrank_2019_sc_190005.pdf https://vbidcenter.org/wp-content/uploads/2021/10/jama_shran...
    - skyyler 4y ago
      https://www.usaspending.gov/agency/department-of-defense#:~:text=Each%20year%20federal%20agencies%20receive,making%20financial%20promises%20called%20obligations%20 https://www.usaspending.gov/agency/department-of-defense#:~:.... >In FY 2022, the Department of Defense (DOD) had $1.64 Trillion distributed among its 6 sub-components. Where are you getting this 767B number?
      - ch4s3 4y ago
        The treasury department’s website[1]. I wonder if your link is rolling in the VA? I can’t quite tell. [1] https://fiscaldata.treasury.gov/americas-finance-guide/federal-spending/ https://fiscaldata.treasury.gov/americas-finance-guide/feder...
        skyyler 4y ago
        >Department of Defense--Military Programs I wonder if that means they're subtracting portions of the DoD budget that aren't technically military operations.
        ch4s3 4y ago
        As with many of these categories it can be hard to pin down accurate numbers.
Mezzie 4y ago
What's terrible about it? I'm a younger (34) person with substantial healthcare needs (I have MS). Everything is always oriented towards the old, and I also pay taxes that are used to support them while getting nothing in return despite having similar needs.
- notacoward 4y ago
  > I also pay taxes Do you really get nothing? And who is paying for whose care? You mention taxes, but they've probably been paying taxes even longer. And why do you think health care is a strict quid pro quo anyway? Some of us believe care should be allocated where it's needed, not where it's paid for. Put another way: why is it a problem that they are getting care? Isn't it that you aren't? This doesn't have to be a zero-sum game. If you feel that you're in competition with someone else for care, the problem is pretty clearly that there aren't enough providing it. Saying others have less right to health care is pretty terrible no matter which way the finger points.
  - Mezzie 4y ago
    I wish we (Americans) had universal healthcare, but at this point I'm pretty jaded about that ever coming to pass. So I agree with you there, and your point about them having paid taxes is also a good one. That said, we do care for the elderly because of their vulnerability but we then shit on younger disabled people. Old people can have assets, most younger disabled people can't, and younger disabled people can lose their benefits by getting married. SSA also applies different criteria for disability and makes it functionally impossible to get if you're young enough versus in your 50s or 60s. I'm frustrated at being expected to extend infinite grace to the elderly when receiving very little/none, despite us being similarly vulnerable. I also dislike that in general our culture takes care of the elderly/gives them their dues without asking them to take up the corresponding responsibility. As a group, they care very little about the future. After years fighting/voting for better healthcare, very little has been accomplished. So am I just supposed to suffer and accept I matter less than an old person? That's kind of against basic animal survival instinct. My country seems determined to view it as a quid pro quo, including the elderly.
cliquecover 4y ago
It's horrible but true. How do you budget for and prioritize access to scarce resources?
polishdude20 4y ago
In a way I think this is ok though? Like, when I reach that age I sure as hell hope I'll have more access to doctors than younger people?
notacoward 4y ago
I had a strong reaction to that too. Of course we devote more health-care effort to people in the last 5-10 years of their life, which primarily (but not entirely) means older people. There is practically no world in which that wouldn't be the case, because everyone's health trajectory eventually trends downward. By the time someone reaches the ICU (other than as a result of trauma) not only the immediate problem but likely several others will have progressed to problematic levels. That's also where the most labor- and dollar-intensive treatments tend to be applicable. It's just basic statistics, really. Cars also cost more in maintenance late in their life cycles, and so do many other things. A flat age distribution in the ICU would be super weird and probably an even worse allocation of resources. I don't think the author really meant that to come across as callous as it sounded. Probably just poor choice of words. I'm only addressing it because someone else reading it here might interpret it in more of an "older people stealing from younger ones again" kind of way for demographic or ideological reasons. ETA: it already happened as I was writing this.
MBCook 4y ago
I didn’t read it as an indictment (why are we wasting all this money on people who are dead soon anyway?) but more of just a straight observation that makes sense if you think about it but probably isn’t what most people would expect if asked unprompted.
gopher_space 4y ago
It’s painfully easy to start thinking in numbers when you’re paying six thousand a month to warehouse your grandmother’s body. The number of tests people want to run on someone we all hope dies tomorrow is insane.
- notacoward 4y ago
  Funny, I pay even more than you mention to support my own mother in relative comfort in a nursing home, and I don't find it "painfully easy" to think that way at all. I certainly don't hope she dies tomorrow. You might want to reconsider saying such things in public. Note: my mother, not my grandmother, and I have lived that ordeal for several years. Some interaction is still possible, but recognition has been beyond her for a while. As long as she seems to take some pleasure in her surroundings, no matter how dim or muted the signs, you won't catch me framing my thoughts about her in terms of dollars I could save.
  - chki 4y ago
    I think a more generous reading of the comment you are replying to could be (and probably is reasonable): It is hard to pay a lot of money for somebody that is living in agony with no chance of getting better, where death might be a good option for them personally. I would not understand the comment to criticize supporting people living in relative comfort.
    - notacoward 4y ago
      "Warehousing her body" suggests otherwise. When people talk about someone as a "body" they usually mean insensate IMX. People whose loved ones are in pain tend to use different, even more colorful, language. I know I did, when that was the case.
      - chki 4y ago
        > People whose loved ones are in pain tend to use different, even more colorful, language. The human experience varies wildly and I would not make such assumptions. Caring for somebody without the hope of improvement for years can make you bitter or even resent the person that no longer resembles the one you loved.

by anjc 4y ago

questime 4y ago

Because of demographics this is a problem we will have to confront regardless - do you think medicare/medicaid spending will become 80% of government spending?

virgildotcodes 4y ago
Maybe with higher taxes and a reallocation of defense spending we’d be able to sustain a more humane society for longer. Is it indefinitely sustainable? Not sure. I don’t know if it’s as easy as just extrapolating from recent trends because there may be countless unknowns from biomedical advances to climate destabilized societies to being turned into biological batteries for our machine overlords in the next few centuries.
- ch4s3 4y ago
  Having medicare operate under a fee for service model will never be sustainable in the long run. We already spend $ 755 B on Medicare, which is roughly equivalent to the DoD's $ 767 B, and Medicare is notoriously wasteful[1][2]. [1] https://www.healthaffairs.org/do/10.1377/hpb20220506.432025/ https://www.healthaffairs.org/do/10.1377/hpb20220506.432025/ [2] https://vbidcenter.org/wp-content/uploads/2021/10/jama_shrank_2019_sc_190005.pdf https://vbidcenter.org/wp-content/uploads/2021/10/jama_shran...
  - skyyler 4y ago
    https://www.usaspending.gov/agency/department-of-defense#:~:text=Each%20year%20federal%20agencies%20receive,making%20financial%20promises%20called%20obligations%20 https://www.usaspending.gov/agency/department-of-defense#:~:.... >In FY 2022, the Department of Defense (DOD) had $1.64 Trillion distributed among its 6 sub-components. Where are you getting this 767B number?
    - ch4s3 4y ago
      The treasury department’s website[1]. I wonder if your link is rolling in the VA? I can’t quite tell. [1] https://fiscaldata.treasury.gov/americas-finance-guide/federal-spending/ https://fiscaldata.treasury.gov/americas-finance-guide/feder...
      - skyyler 4y ago
        >Department of Defense--Military Programs I wonder if that means they're subtracting portions of the DoD budget that aren't technically military operations.
        ch4s3 4y ago
        As with many of these categories it can be hard to pin down accurate numbers.

Mezzie 4y ago

What's terrible about it? I'm a younger (34) person with substantial healthcare needs (I have MS). Everything is always oriented towards the old, and I also pay taxes that are used to support them while getting nothing in return despite having similar needs.

notacoward 4y ago
> I also pay taxes Do you really get nothing? And who is paying for whose care? You mention taxes, but they've probably been paying taxes even longer. And why do you think health care is a strict quid pro quo anyway? Some of us believe care should be allocated where it's needed, not where it's paid for. Put another way: why is it a problem that they are getting care? Isn't it that you aren't? This doesn't have to be a zero-sum game. If you feel that you're in competition with someone else for care, the problem is pretty clearly that there aren't enough providing it. Saying others have less right to health care is pretty terrible no matter which way the finger points.
- Mezzie 4y ago
  I wish we (Americans) had universal healthcare, but at this point I'm pretty jaded about that ever coming to pass. So I agree with you there, and your point about them having paid taxes is also a good one. That said, we do care for the elderly because of their vulnerability but we then shit on younger disabled people. Old people can have assets, most younger disabled people can't, and younger disabled people can lose their benefits by getting married. SSA also applies different criteria for disability and makes it functionally impossible to get if you're young enough versus in your 50s or 60s. I'm frustrated at being expected to extend infinite grace to the elderly when receiving very little/none, despite us being similarly vulnerable. I also dislike that in general our culture takes care of the elderly/gives them their dues without asking them to take up the corresponding responsibility. As a group, they care very little about the future. After years fighting/voting for better healthcare, very little has been accomplished. So am I just supposed to suffer and accept I matter less than an old person? That's kind of against basic animal survival instinct. My country seems determined to view it as a quid pro quo, including the elderly.

cliquecover 4y ago

It's horrible but true. How do you budget for and prioritize access to scarce resources?

polishdude20 4y ago

In a way I think this is ok though? Like, when I reach that age I sure as hell hope I'll have more access to doctors than younger people?

notacoward 4y ago

I had a strong reaction to that too. Of course we devote more health-care effort to people in the last 5-10 years of their life, which primarily (but not entirely) means older people. There is practically no world in which that wouldn't be the case, because everyone's health trajectory eventually trends downward. By the time someone reaches the ICU (other than as a result of trauma) not only the immediate problem but likely several others will have progressed to problematic levels. That's also where the most labor- and dollar-intensive treatments tend to be applicable. It's just basic statistics, really. Cars also cost more in maintenance late in their life cycles, and so do many other things. A flat age distribution in the ICU would be super weird and probably an even worse allocation of resources. I don't think the author really meant that to come across as callous as it sounded. Probably just poor choice of words. I'm only addressing it because someone else reading it here might interpret it in more of an "older people stealing from younger ones again" kind of way for demographic or ideological reasons. ETA: it already happened as I was writing this.

MBCook 4y ago

I didn’t read it as an indictment (why are we wasting all this money on people who are dead soon anyway?) but more of just a straight observation that makes sense if you think about it but probably isn’t what most people would expect if asked unprompted.

gopher_space 4y ago

It’s painfully easy to start thinking in numbers when you’re paying six thousand a month to warehouse your grandmother’s body. The number of tests people want to run on someone we all hope dies tomorrow is insane.

notacoward 4y ago
Funny, I pay even more than you mention to support my own mother in relative comfort in a nursing home, and I don't find it "painfully easy" to think that way at all. I certainly don't hope she dies tomorrow. You might want to reconsider saying such things in public. Note: my mother, not my grandmother, and I have lived that ordeal for several years. Some interaction is still possible, but recognition has been beyond her for a while. As long as she seems to take some pleasure in her surroundings, no matter how dim or muted the signs, you won't catch me framing my thoughts about her in terms of dollars I could save.
- chki 4y ago
  I think a more generous reading of the comment you are replying to could be (and probably is reasonable): It is hard to pay a lot of money for somebody that is living in agony with no chance of getting better, where death might be a good option for them personally. I would not understand the comment to criticize supporting people living in relative comfort.
  - notacoward 4y ago
    "Warehousing her body" suggests otherwise. When people talk about someone as a "body" they usually mean insensate IMX. People whose loved ones are in pain tend to use different, even more colorful, language. I know I did, when that was the case.
    - chki 4y ago
      > People whose loved ones are in pain tend to use different, even more colorful, language. The human experience varies wildly and I would not make such assumptions. Caring for somebody without the hope of improvement for years can make you bitter or even resent the person that no longer resembles the one you loved.