Friday, December 31, 2010

Something's Coming at the Healthcare Industry

I keep seeing these articles pop up... man, I see TPTB coming after physicians the way they came after Wall Street for the past 20 years... audit after audit (been there, done that... its like having an autopsy done on you without the benefit of being dead), crawling through your life, second guessing all of your decisions with the benefit of hindsight... given how badly the industry is ripping off the system I don't see how the largest payor (government) does not find a way to "incentivise" healthcare practitioners to make do with less income.

Medicare sowed the seeds of its own demise at its conception.  One look at the population graphs in National Geographic's latest "Population 7 Billion" at it was "POOF!!  Epiphany!!"  I love numbers. People lie, math does not.  All the silly things people say to support something they find appealing, irrespective of its sustainability, such as "a society should be judged by how it treats fill-in-the-blank"... you see math does not care, not even a little bit, what you think is fair, right, or just... in fact, its the people that use these impossible terms to support their un-analyzed position that make solutions politically impossible.

Just look at some of the lies, distortions, and outright manipulations contained in this article:

The system has worked for 45 years, with occasional fine tuning. But the retirement of the baby boomers, the first of whom become eligible for Medicare in 2011, threatens to push it over the edge.
Really??!! Well, sort of... it worked because of the population trends occurring during the period, and just as surely will absolutely no longer work when those trends reverse or change.  Sheeshh!

There are some hard and accurate numbers, though for the most part the article fails to calculate the net effect of compounding:

A single woman who retired in 1980, after earning average wages throughout her career, could expect to receive medical care worth about $74,800 over the rest of her lifetime. A comparable woman retiring in 2010 can expect services worth $181,000. Those numbers are in 2010 dollars, adjusted for inflation so they can be compared directly.
The life span of the $800,000 per year spinal surgeon is about to be cut quite short.

I expect the attack will have several fronts - unnecessary surgical treatments will be up there, but the attack on over-presribed diagnostic tests will be most intense... you know, MRI, CT, PET et al... especially for the Medicare age set.  How does it help a patient to KNOW what they are going to die from?  Especially if, because of age or malady, there are no real opportunities to extend length or quality to life?  Hell, I am 50 soon, and I told my physician there is no point in checking my prostate anymore, because I am willing to take my chances, and would be unwilling to undergo treatment.  For every 50 people that are found with prostate cancer, over 42 would have eventually died of something else. No one lives forever... so what's the point of being stressed to death, or impotent or incontinent while you wait for the bitter end?  As Kurt Cobain said:  "We are not here for a long time. We're here for a good time". Hard to have a good time with the side effects of prostate surgery...

(When my 78 year old father was diagnosed with terminal liver cancer, he got up, shook the physicians hand, and said "thanks for everything", and got up to leave.  The doctor said "I'd like to discuss treatment options"... to which my father said "on the other side of the torture, I mean treatment, am I going to be any healthier than I am now?  No? Then I am going to enjoy what time I have left.  Good luck, Doc."  My father left, and never returned for treatment, except for hospice care at the end.  My father enjoyed about 20 months of reasonably good health after the diagnosis, playing baseball everyday and dancing with my mother every night... before his health really deteriorated.  Yes, he might have extended his life by a couple of months had he begun treatment that day... but would he have enjoyed a total 20 months of life post-diagnosis?  NAFC. My old man was the original tough guy; the Real Deal.)

The Healthcare Industry is the new Wall Street as far as government regulation is concerned.

We don't have a "Healthcare Crisis" anymore than we have a "Housing Crisis".  What we have is a "Healthcare FINANCE Crisis" and a "Housing FINANCE Crisis" (though that being cured as we speak by lower prices).  Healthcare cannot remain 18% of U.S. GDP; healthcare will need to provide the same services it does now for about 13% of GDP.  How that comes about remains to be seen... not the outcome.

"Its rough out there."


bureaucrat said...

The Frontline (PBS) piece several weeks ago said it pretty plainly ... for all the bravado of brave American men and women as they face their imminent death from something ... no matter what it cost, they all wanted EVERYTHING done to treat them to live another day. That is what is killing Medicare -- a lack of acknowledging financial reality -- which has been the theme for the 30 years the baby boomers have ruled America.

For the one guy like your dad who courageously turned down treatment, ten more will say "do everything possible, no matter what it costs." Humans rarely want to die. 90-year old grandma was hoping for a miracle till her last day, so I'm told.

Dextred1 said...

Jeffers, Einstein said the same thing in a different way "People lie, math does not".

"Politics is for the present, but an equation is for eternity.”

Your Dad reminds of my grandpa's. They were both marines and thought and lived the same way. Those men were made different than the men now. By the way that is the highest compliment I can give your dad, both my grandpas were great men.

Greg T. Jeffers said...

My father was the REAL John Wayne... tough as you got. Just a regular guy... but with real steel in his b*lls. I hope to handle my end half as gracefully.

Greg T. Jeffers said...

Not that my father was suicidal... he just did the math... by foregoing treatment he got more healthy and happy LIFE under his belt. Had he started treatment upon diagnosis, he would have spent 2 or 3 years very, very sick or have 20 months in pretty good health... I watched the whole thing unfold, and was in awe of the man.

kathy said...

I know we don't always see eye to eye on things, Greg but I admire you and have learned more here than anywhere else on the net. I am wishing you a happy and prosperous New Years. (even entrenched Massachusetts residents can count).


Greg T. Jeffers said...


I think you and I see things not so far apart as you imagine... but I thank you for that very nice compliment and wish for you and yours a happy, healthy, prosperous (however you define that), and fun New Year!

Dan.Eliot said...
This comment has been removed by a blog administrator.
westexas said...

Michael Cain thinks that Medicaid may be in the crosshairs in several states:

Anonymous said...

lots of grace in these words. love you hannah. buscar pareja internet
como saber si estoy en asnef
Ayuda para dejar de fumar


Healthcare is a real mess