3 ms·

Old people vote the most and "death panel" rhetoric works really well. This is the result unfortunately. Overprescription is generally a huge problem in medicin

Old people vote the most and "death panel" rhetoric works really well. This is the result unfortunately. Overprescription is generally a huge problem in medicine because of asymmetric information and the incentive structure that fee for service creates. That's why medicare is trying to move to a capitated system in which health care providers get paid per patient they cover per year, not per service they provide.

toomuchtodo 4y ago
A significant amount of healthcare spending is in the last year of life due to an unhealthy relationship with death at a cultural level. Until that changes, people will commit to exhausting healthcare and medical resources to cling on to the last part of life (note: I am not advocating for withholding care when a positive outcome is possible, and I have had to make end of life care decisions for loved ones). There is also evidence the system is incentivized to consume resources versus allowing someone to choose to die at home. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/ (Medicare Cost at End of Life) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2708119/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2708119/ (Place of Death Among Older Americans) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5326787/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5326787/ (Thanatophobia (Death Anxiety) in the Elderly: The Problem of the Child’s Inability to Assess Their Own Parent’s Death Anxiety State)
- HDThoreaun 4y ago
  Good luck changing people's fear of death in this country. Properly disincentivizing interventions that don't work or aren't cost effective is the only solution.
  - s1artibartfast 4y ago
    I don't think you have to deal with incentives at all. We can simply stop paying for low or negative Roi treatments
    - HDThoreaun 4y ago
      This is where the death panel rhetoric comes in. As soon as medicare recipients realize their doctor is recommending stuff that some panel has decided they won't pay for politicians are in big, big trouble. "How dare the government claim they know better than my doctor" type of stuff works really well
      - toomuchtodo 4y ago
        You're not wrong, progress here is going to be governed by the velocity at which younger voters become a larger voting bloc than the elderly. https://thehill.com/changing-america/respect/diversity-inclusion/3730922-researchers-say-2022-election-had-second-highest-young-voter-turnout-in-last-30-years/ https://thehill.com/changing-america/respect/diversity-inclu... https://www.pewresearch.org/fact-tank/2018/04/03/millennials-approach-baby-boomers-as-largest-generation-in-u-s-electorate/ https://www.pewresearch.org/fact-tank/2018/04/03/millennials... https://www.pewresearch.org/wp-content/uploads/2018/04/FT_16.05.13_eligibleMillennialVoters.png https://www.pewresearch.org/wp-content/uploads/2018/04/FT_16... Edit: https://www.populationpyramid.net/united-states-of-america/2023/ https://www.populationpyramid.net/united-states-of-america/2...
        thfuran 4y ago
        Aren't demographics heading in the wrong direction for that?
        toomuchtodo 4y ago
        https://www.morningstar.com/news/marketwatch/20230314284/baby-boomers-now-outnumbered-by-millennials-see-a-shift-in-generational-power https://www.morningstar.com/news/marketwatch/20230314284/bab... https://www.pewresearch.org/fact-tank/2020/04/28/millennials-overtake-baby-boomers-as-americas-largest-generation/ https://www.pewresearch.org/fact-tank/2020/04/28/millennials... https://www.brookings.edu/blog/the-avenue/2020/07/30/now-more-than-half-of-americans-are-millennials-or-younger/ https://www.brookings.edu/blog/the-avenue/2020/07/30/now-mor...
- webnrrd2k 4y ago
  No one asked, and not exactly on topic, but I'd like to throw in my $0.02 towards our culture having a slightly less unhealthy relationship with death. The essence of it is this: No one suffers over how they don't exist on, say, the top of Mount Everest right now, or the bottom of the Marianas trench. They also don't worry about how they didn't exist in the 12th century in Madagascar, or on the surface of Mars one million years ago. No one worries that they don't exist in the center of the Sun, or on the surface of some star in some other part of the universe. There is an almost infinite number of places and times that I currently don't exist at. I think that death is like that. There is no one to worry about anything, just like you weren't there to worry about anything before you were born. I went to a junior college that I spent time at years ago, and, being in the physical location made it easy to place myself in the mental space I was at then... The person I was then, the things that were important then, everything, all of it, are now gone. I have memories of that time... some sad, some happy, some bittersweet. But the person I was then is gone, no longer exists in any real way. It's easy to get swept up in those memories and the emotions, but, if I focus on what's going on in the present moment, then it's clear that none of that exists any longer (at least not outside my memories). And that's a good thing! It frees up the present moment for doing new things, for becoming someone else. I'm not trying to get all nihilistic "nothing matters", and I'm also not all New Age "everything is going to be perfect". There are real problems in the world, and some seriously f*cked things happen. But working on real problems is hard enough without dragging a bunch of anxiety over fantasies into it.
rootusrootus 4y ago
The joke, of course, is that we have death panels already. They're even less accountable than the government. What I don't understand is how so many people think it would be worse with the government running the show, given we already know exactly how terrible the private insurance companies are.
- WalterBright 4y ago
  It's worse with government because of the scale. The math of Medicare is that if it is not restrained, it will consume the economy.
  - yowzadave 4y ago
    > It's worse with government because of the scale. Can you explain what you mean by this? Why would the cost per-person be greater? Are there not opportunities to take advantage of economies of scale? And to benefit from not needing to achieve profits for the shareholders of insurance companies?
  - rootusrootus 4y ago
    Are you assuming that Medicare gets no additional funding? My assumption is that every dollar which currently goes to insurance companies as premium ends up going to Medicare[0]. Medicaid would have no reason to exist any more either, it would become part of the same program. The only way this ends up being more expensive than what we have now is if we must cover a bunch of people who are currently doing without health care. There's a really obvious moral question that comes up right about then, we can skip that. The actual number of truly uninsured people (no private insurance, no medicaid) is relatively small. That would be offset by all the money we don't spend on medical billing and insurance company bureaucracy. [0] or whatever it would be called, Medicare is a nice name but I'm talking single payer

toomuchtodo 4y ago

A significant amount of healthcare spending is in the last year of life due to an unhealthy relationship with death at a cultural level. Until that changes, people will commit to exhausting healthcare and medical resources to cling on to the last part of life (note: I am not advocating for withholding care when a positive outcome is possible, and I have had to make end of life care decisions for loved ones). There is also evidence the system is incentivized to consume resources versus allowing someone to choose to die at home. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/ (Medicare Cost at End of Life) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2708119/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2708119/ (Place of Death Among Older Americans) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5326787/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5326787/ (Thanatophobia (Death Anxiety) in the Elderly: The Problem of the Child’s Inability to Assess Their Own Parent’s Death Anxiety State)

HDThoreaun 4y ago
Good luck changing people's fear of death in this country. Properly disincentivizing interventions that don't work or aren't cost effective is the only solution.
- s1artibartfast 4y ago
  I don't think you have to deal with incentives at all. We can simply stop paying for low or negative Roi treatments
  - HDThoreaun 4y ago
    This is where the death panel rhetoric comes in. As soon as medicare recipients realize their doctor is recommending stuff that some panel has decided they won't pay for politicians are in big, big trouble. "How dare the government claim they know better than my doctor" type of stuff works really well
    - toomuchtodo 4y ago
      You're not wrong, progress here is going to be governed by the velocity at which younger voters become a larger voting bloc than the elderly. https://thehill.com/changing-america/respect/diversity-inclusion/3730922-researchers-say-2022-election-had-second-highest-young-voter-turnout-in-last-30-years/ https://thehill.com/changing-america/respect/diversity-inclu... https://www.pewresearch.org/fact-tank/2018/04/03/millennials-approach-baby-boomers-as-largest-generation-in-u-s-electorate/ https://www.pewresearch.org/fact-tank/2018/04/03/millennials... https://www.pewresearch.org/wp-content/uploads/2018/04/FT_16.05.13_eligibleMillennialVoters.png https://www.pewresearch.org/wp-content/uploads/2018/04/FT_16... Edit: https://www.populationpyramid.net/united-states-of-america/2023/ https://www.populationpyramid.net/united-states-of-america/2...
      - thfuran 4y ago
        Aren't demographics heading in the wrong direction for that?
        toomuchtodo 4y ago
        https://www.morningstar.com/news/marketwatch/20230314284/baby-boomers-now-outnumbered-by-millennials-see-a-shift-in-generational-power https://www.morningstar.com/news/marketwatch/20230314284/bab... https://www.pewresearch.org/fact-tank/2020/04/28/millennials-overtake-baby-boomers-as-americas-largest-generation/ https://www.pewresearch.org/fact-tank/2020/04/28/millennials... https://www.brookings.edu/blog/the-avenue/2020/07/30/now-more-than-half-of-americans-are-millennials-or-younger/ https://www.brookings.edu/blog/the-avenue/2020/07/30/now-mor...
webnrrd2k 4y ago
No one asked, and not exactly on topic, but I'd like to throw in my $0.02 towards our culture having a slightly less unhealthy relationship with death. The essence of it is this: No one suffers over how they don't exist on, say, the top of Mount Everest right now, or the bottom of the Marianas trench. They also don't worry about how they didn't exist in the 12th century in Madagascar, or on the surface of Mars one million years ago. No one worries that they don't exist in the center of the Sun, or on the surface of some star in some other part of the universe. There is an almost infinite number of places and times that I currently don't exist at. I think that death is like that. There is no one to worry about anything, just like you weren't there to worry about anything before you were born. I went to a junior college that I spent time at years ago, and, being in the physical location made it easy to place myself in the mental space I was at then... The person I was then, the things that were important then, everything, all of it, are now gone. I have memories of that time... some sad, some happy, some bittersweet. But the person I was then is gone, no longer exists in any real way. It's easy to get swept up in those memories and the emotions, but, if I focus on what's going on in the present moment, then it's clear that none of that exists any longer (at least not outside my memories). And that's a good thing! It frees up the present moment for doing new things, for becoming someone else. I'm not trying to get all nihilistic "nothing matters", and I'm also not all New Age "everything is going to be perfect". There are real problems in the world, and some seriously f*cked things happen. But working on real problems is hard enough without dragging a bunch of anxiety over fantasies into it.

rootusrootus 4y ago

The joke, of course, is that we have death panels already. They're even less accountable than the government. What I don't understand is how so many people think it would be worse with the government running the show, given we already know exactly how terrible the private insurance companies are.

WalterBright 4y ago
It's worse with government because of the scale. The math of Medicare is that if it is not restrained, it will consume the economy.
- yowzadave 4y ago
  > It's worse with government because of the scale. Can you explain what you mean by this? Why would the cost per-person be greater? Are there not opportunities to take advantage of economies of scale? And to benefit from not needing to achieve profits for the shareholders of insurance companies?
- rootusrootus 4y ago
  Are you assuming that Medicare gets no additional funding? My assumption is that every dollar which currently goes to insurance companies as premium ends up going to Medicare[0]. Medicaid would have no reason to exist any more either, it would become part of the same program. The only way this ends up being more expensive than what we have now is if we must cover a bunch of people who are currently doing without health care. There's a really obvious moral question that comes up right about then, we can skip that. The actual number of truly uninsured people (no private insurance, no medicaid) is relatively small. That would be offset by all the money we don't spend on medical billing and insurance company bureaucracy. [0] or whatever it would be called, Medicare is a nice name but I'm talking single payer