6 ms·

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medica

It's politically toxic to discuss but a ton of money goes to keeping people not dead (not really alive either). You could give a lot more people medicare/medicaid if we let a 90 yr old with dementia/diatebetes/etc. pass with dignity.

voz_ 4y ago
I don't think its politically toxic, but rather, extremely humane that we care for our elderly. The real unfortunate part is that we, in the working class, have to make due with sharing slices of the pie so more money can go to our exploiters and owners - especially in the US, we are such a wealthy nation, and yet here we are bickering around who deserves care based on age. Sad.
- MBCook 4y ago
  > I don't think its politically toxic Ever hear of the Obamacare death panels? The ones where doctors would decide if your loved one was too old and shouldn’t get treatment? Yeah. That’s this. What it really was that Medicare would pay for consultation with doctors (?) to discuss end of life care and setup living wills and DNRs and such if the person wanted. That way if something happened and they were taken to the hospital they could be treated the way they wanted to be and not stuck in a coma on a vent for the rest of their life if that was against their wishes. But the Republicans branded then “death panels” (which for political purposes was brilliant). So the choice of having help making those decisions was removed.
- questime 4y ago
  I disagree, spending on these things is growing at 2x GDP growth so yes more of the pie is going to this. What I'm suggesting is that at some point the pie isn't big enough for this. No matter what happens eventually standard of care will roll back/fewer people will be covered etc. Ideally we can innovate out of this situation but after spending 8 years working in healthcare I've gotten cynical about it.
- neonate 4y ago
  We don't care for our elderly. We fear death. If our society really cared for the elderly, they would be integrated and respected, not segregated and shunned. We do the latter because we fear age, sickness, and death. Fear isn't caring.
  - rscho 4y ago
    > We fear death In the US. It's perhaps the most striking difference that hit me during my stay overseas. In the Old World we occasionally get people completely panicking about their own death. In the US, seemingly _everyone_ is like that.
    - neonate 4y ago
      I'd like to hear how elders are treated in these societies that don't fear death as much.
      - rscho 4y ago
        I'd wager: not very differently. But not out of fear. The social isolation of old age is the same everywhere. Young people have their own lives to live.
        neonate 4y ago
        > The social isolation of old age is the same everywhere That is certainly not true. Traditional societies and non-western societies have far different ways of relating to elders than we do, and even among western societies there are variations.
        rscho 4y ago
        Well, yes I see what you mean. What I meant was: it's the same in the US and western Europe. But certainly if you go to more "old fashioned" places, the elderly usually live with the family and are taken care of. To be fair, this still happens even in "advanced" western societies. I seem to recall this also goes together with a lot of elderly abuse.
itestyourcode 4y ago
Is it the same dilemma if we can kill one to save more?
wellareyousure 4y ago
Yes, certainly people in medicine are aware. > we let a 90 yr old with dementia/diatebetes/etc. pass with dignity. Often it's a 4 week old baby. For every 1 sophisticated family member, there are 19 unsophisticated ones, who toss a weighted coin and, if it's heads, they decide they want their dying, non-responsive relative - possibly their baby, possibly their mom, etc. - to be kept alive at all costs. I don't know if this is politically toxic as much as it is cultural, and possibly globally cultural.
- questime 4y ago
  > Often it's a 4 week old baby. You are stretching the word often, most people in the ICU are close to the end of their life. A lot of people don't realize but most of the time if you needed to spend weeks in an ICU you are probably not "living" in a dignified way. Almost all ICU doctors/nurses I've talked to would rather have a DNR in their old age than live like that.
  - Eleison23 4y ago
    Your human dignity is not predicated on how much pain you're in, how awake you are, or how able you are.
    - Der_Einzige 4y ago
      Uhh, yes it is to all three of those things. If I'm in pain, am delirious, and am unable to operate in the world. I've lost my dignity.
      - Eleison23 4y ago
        Just because you feel undignified, or humiliated, or useless, does not mean that you are. Don't swallow the lies.
    - IX-103 4y ago
      You mean yours. My human dignity does depend on whether I have to endure the rest of my life pooping my pants, not remembering my own name, and hooked up to some noisy machine telling my lungs to breathe and my heart to beat.
z3rgl1ng 4y ago
This is an oft-repeated piece of received wisdom that is empirically untrue. https://www.statnews.com/2018/06/28/end-of-life-health-spending/ https://www.statnews.com/2018/06/28/end-of-life-health-spend...
- robocat 4y ago
  Wow: just sample bias! We need to also look at the old people who had expensive care and survived (95% of costs in that article). Money does gets spent on hospital care just before death (5%), but predicting how to avoid “wasting” that money is hard.
- deleted 4y ago
  [deleted]
chiefalchemist 4y ago
Many of the top causes of death, per the CDC, are from diseases that can be prevented or naturally mitigated. We're all going to get old. We're all going to die. But carrying two or more "pre-existing conditions" into your later years is going to decrease your quality of life, as well as your use of healthcare. My point is, what's not sociopolitically allowed is discussing how personal choice as well as normalized systematic issues (e.g., urban food deserts) are killing us, slowly. It's unfashionable to suggest someone's weight is (ultimately) unhealthy. But the USA wants to have its cake and eat it too, literally. That's not working out. It's not sustainable. Finally, not to get off topic but over the last couple of weeks there's been a thread or two on HN based on acticles suggesting the GDP and similar "classics" economic metrics are hiding underlying social issues. That is, for example, healthcare care contributes to the GDP (or whatever) but that healthcare is for diabetes, opioids, faltering mental health, etc. We're falling apart but not to worry the economy is doing just fine. It's complicated. But to your point, the fact that some important topics are ofc limits isn't helping. Until that changes the status quo will continue.
- ryandrake 4y ago
  > My point is, what's not sociopolitically allowed is discussing how personal choice as well as normalized systematic issues (e.g., urban food deserts) are killing us, slowly. It's unfashionable to suggest someone's weight is (ultimately) unhealthy. The recent push to try to re-frame obesity as healthy, fashionable and sexy seems particularly bizarre and unexplainable. It's the opposite of what happened with cigarettes, which started out as fashionable and healthy, then slowly became known as unhealthy and finally fell out of cultural fashion.
  - lazyasciiart 4y ago
    I think the root of it is recognition that mental health is as important as physical health, and that losing weight isn’t as easy as many people assume, and shouldn’t be done the way many people try - so actively shaming and criticizing fat people for being fat is of negative health utility overall.
ch4s3 4y ago
It's pretty well know and often discussed that up to 1/3 of Medicare spending is wasted. Being fee for service doesn't help but neither does spending 13-25% of all medicare dollars on end of life care[1]. What's worse is how much of Medicare's wasted spending goes to harmful treatments. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/#:~:text=A%20major%20source%20of%20expense,depending%20on%20methods%20and%20assumptions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/#:~:tex....
croes 4y ago
Where do you draw the line? At what age, what illness do you refuse to treat a patient even though he may not want to die? You could give a lot of people medical treatment with a proper healthcare and tax system. Why don't we try that first?
- toast0 4y ago
  > Where do you draw the line? At what age 30? or 21, if you prefer the book ;p
- coryrc 4y ago
  At some QALY/$.
  - Fomite 4y ago
    QALYs are hardly non-controversial.
    - hnfong 4y ago
      The original comment by questime literally said we should discuss the general topic even though it's controversial.
- roxgib 4y ago
  I assume we start by getting more information from patients about their wishes, and then following them accordingly. A large number of elderly people don't want hopeless and unpleasant medical interventions, but end up having them anyway because no one asked them.
TheOtherHobbes 4y ago
Any form of euthanasia runs into the legal and moral problem of who decides? And why? You might think everyone wants to act in the best interests of their relatives, but of course that's not true. Some people will want to speed the natural process along because that inheritance looks really appealing, and no one is really going to miss the old guy/gal anyway. Besides, that's not really the problem. The problem is profiteering by insurance companies and the hospitals they (effectively) run for profit, with patient wellbeing as a regrettable requirement they have to put some effort into.
Sevii 4y ago
Canada is actually moving in that direction with their medical assistance in dying laws.

voz_ 4y ago

I don't think its politically toxic, but rather, extremely humane that we care for our elderly. The real unfortunate part is that we, in the working class, have to make due with sharing slices of the pie so more money can go to our exploiters and owners - especially in the US, we are such a wealthy nation, and yet here we are bickering around who deserves care based on age. Sad.

MBCook 4y ago
> I don't think its politically toxic Ever hear of the Obamacare death panels? The ones where doctors would decide if your loved one was too old and shouldn’t get treatment? Yeah. That’s this. What it really was that Medicare would pay for consultation with doctors (?) to discuss end of life care and setup living wills and DNRs and such if the person wanted. That way if something happened and they were taken to the hospital they could be treated the way they wanted to be and not stuck in a coma on a vent for the rest of their life if that was against their wishes. But the Republicans branded then “death panels” (which for political purposes was brilliant). So the choice of having help making those decisions was removed.
questime 4y ago
I disagree, spending on these things is growing at 2x GDP growth so yes more of the pie is going to this. What I'm suggesting is that at some point the pie isn't big enough for this. No matter what happens eventually standard of care will roll back/fewer people will be covered etc. Ideally we can innovate out of this situation but after spending 8 years working in healthcare I've gotten cynical about it.
neonate 4y ago
We don't care for our elderly. We fear death. If our society really cared for the elderly, they would be integrated and respected, not segregated and shunned. We do the latter because we fear age, sickness, and death. Fear isn't caring.
- rscho 4y ago
  > We fear death In the US. It's perhaps the most striking difference that hit me during my stay overseas. In the Old World we occasionally get people completely panicking about their own death. In the US, seemingly _everyone_ is like that.
  - neonate 4y ago
    I'd like to hear how elders are treated in these societies that don't fear death as much.
    - rscho 4y ago
      I'd wager: not very differently. But not out of fear. The social isolation of old age is the same everywhere. Young people have their own lives to live.
      - neonate 4y ago
        > The social isolation of old age is the same everywhere That is certainly not true. Traditional societies and non-western societies have far different ways of relating to elders than we do, and even among western societies there are variations.
        rscho 4y ago
        Well, yes I see what you mean. What I meant was: it's the same in the US and western Europe. But certainly if you go to more "old fashioned" places, the elderly usually live with the family and are taken care of. To be fair, this still happens even in "advanced" western societies. I seem to recall this also goes together with a lot of elderly abuse.

itestyourcode 4y ago

Is it the same dilemma if we can kill one to save more?

wellareyousure 4y ago

Yes, certainly people in medicine are aware. > we let a 90 yr old with dementia/diatebetes/etc. pass with dignity. Often it's a 4 week old baby. For every 1 sophisticated family member, there are 19 unsophisticated ones, who toss a weighted coin and, if it's heads, they decide they want their dying, non-responsive relative - possibly their baby, possibly their mom, etc. - to be kept alive at all costs. I don't know if this is politically toxic as much as it is cultural, and possibly globally cultural.

questime 4y ago
> Often it's a 4 week old baby. You are stretching the word often, most people in the ICU are close to the end of their life. A lot of people don't realize but most of the time if you needed to spend weeks in an ICU you are probably not "living" in a dignified way. Almost all ICU doctors/nurses I've talked to would rather have a DNR in their old age than live like that.
- Eleison23 4y ago
  Your human dignity is not predicated on how much pain you're in, how awake you are, or how able you are.
  - Der_Einzige 4y ago
    Uhh, yes it is to all three of those things. If I'm in pain, am delirious, and am unable to operate in the world. I've lost my dignity.
    - Eleison23 4y ago
      Just because you feel undignified, or humiliated, or useless, does not mean that you are. Don't swallow the lies.
  - IX-103 4y ago
    You mean yours. My human dignity does depend on whether I have to endure the rest of my life pooping my pants, not remembering my own name, and hooked up to some noisy machine telling my lungs to breathe and my heart to beat.

z3rgl1ng 4y ago

This is an oft-repeated piece of received wisdom that is empirically untrue. https://www.statnews.com/2018/06/28/end-of-life-health-spending/ https://www.statnews.com/2018/06/28/end-of-life-health-spend...

robocat 4y ago
Wow: just sample bias! We need to also look at the old people who had expensive care and survived (95% of costs in that article). Money does gets spent on hospital care just before death (5%), but predicting how to avoid “wasting” that money is hard.
deleted 4y ago
[deleted]

chiefalchemist 4y ago

Many of the top causes of death, per the CDC, are from diseases that can be prevented or naturally mitigated. We're all going to get old. We're all going to die. But carrying two or more "pre-existing conditions" into your later years is going to decrease your quality of life, as well as your use of healthcare. My point is, what's not sociopolitically allowed is discussing how personal choice as well as normalized systematic issues (e.g., urban food deserts) are killing us, slowly. It's unfashionable to suggest someone's weight is (ultimately) unhealthy. But the USA wants to have its cake and eat it too, literally. That's not working out. It's not sustainable. Finally, not to get off topic but over the last couple of weeks there's been a thread or two on HN based on acticles suggesting the GDP and similar "classics" economic metrics are hiding underlying social issues. That is, for example, healthcare care contributes to the GDP (or whatever) but that healthcare is for diabetes, opioids, faltering mental health, etc. We're falling apart but not to worry the economy is doing just fine. It's complicated. But to your point, the fact that some important topics are ofc limits isn't helping. Until that changes the status quo will continue.

ryandrake 4y ago
> My point is, what's not sociopolitically allowed is discussing how personal choice as well as normalized systematic issues (e.g., urban food deserts) are killing us, slowly. It's unfashionable to suggest someone's weight is (ultimately) unhealthy. The recent push to try to re-frame obesity as healthy, fashionable and sexy seems particularly bizarre and unexplainable. It's the opposite of what happened with cigarettes, which started out as fashionable and healthy, then slowly became known as unhealthy and finally fell out of cultural fashion.
- lazyasciiart 4y ago
  I think the root of it is recognition that mental health is as important as physical health, and that losing weight isn’t as easy as many people assume, and shouldn’t be done the way many people try - so actively shaming and criticizing fat people for being fat is of negative health utility overall.

ch4s3 4y ago

It's pretty well know and often discussed that up to 1/3 of Medicare spending is wasted. Being fee for service doesn't help but neither does spending 13-25% of all medicare dollars on end of life care[1]. What's worse is how much of Medicare's wasted spending goes to harmful treatments. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/#:~:text=A%20major%20source%20of%20expense,depending%20on%20methods%20and%20assumptions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/#:~:tex....

croes 4y ago

Where do you draw the line? At what age, what illness do you refuse to treat a patient even though he may not want to die? You could give a lot of people medical treatment with a proper healthcare and tax system. Why don't we try that first?

toast0 4y ago
> Where do you draw the line? At what age 30? or 21, if you prefer the book ;p
coryrc 4y ago
At some QALY/$.
- Fomite 4y ago
  QALYs are hardly non-controversial.
  - hnfong 4y ago
    The original comment by questime literally said we should discuss the general topic even though it's controversial.
roxgib 4y ago
I assume we start by getting more information from patients about their wishes, and then following them accordingly. A large number of elderly people don't want hopeless and unpleasant medical interventions, but end up having them anyway because no one asked them.

TheOtherHobbes 4y ago

Any form of euthanasia runs into the legal and moral problem of who decides? And why? You might think everyone wants to act in the best interests of their relatives, but of course that's not true. Some people will want to speed the natural process along because that inheritance looks really appealing, and no one is really going to miss the old guy/gal anyway. Besides, that's not really the problem. The problem is profiteering by insurance companies and the hospitals they (effectively) run for profit, with patient wellbeing as a regrettable requirement they have to put some effort into.

Sevii 4y ago

Canada is actually moving in that direction with their medical assistance in dying laws.