Ezra Klein: Link of the Day: Hard Truths Edition

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January 30, 2006

Link of the Day: Hard Truths Edition

Why intelligently rationing health care is the worst system -- except for all the others. And while reading, keep in mind that we already ration health care, we just do it by income, wealth, and region. Moreover, we overtreat, particularly at the end of life, to a truly remarkable degree, one that has little or no impact on mortality rates or longevity.

January 30, 2006 | Permalink

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Comments

Ezra, you might want to look into the Oregon Health Plan (OHP), an attempt a few years ago by the major stakeholders to rationally determine what treatments would be covered for essentially the entire spectrum of health problems, looking carefully at cost-effectiveness. The program appears to have worked as intended until the costs of MedicAid (and other state budget problems - OR has no state sales tax) overwhelmed things.

In regard to late-in-life treatments (or end-life), I suspect but can't show, that people don't want a slow, painful death, and urge onto their physicians any treatments that postpone that period of their life.

Oregon's repeated approval of physician prescriptions for patients to terminate their life with drugs within 6 months of a two-doctor prognosis of death says something about this attitude, although in actuality only few patients do take the drugs. It seems like patients view this option as 'insurance' against a painful and helpless end.

I also think this end-care issue is largely a family social compact issue. The family wants to support the patient in any way, and high-tech care is the way they express their feelings - and reduce any possible feelings of guilt as well.

I don't see how other nations deal with this late-in life, nearing-dealth, cost control issue. How does a MD refrain from ordering expensive care? How do the patients and their families accept this situation? I find things like hip replacements perfectly justifiable, but prolonged machine breathing or IV feeding not justifiable - but I can't explain why, exactly.

Posted by: JimPortandOR | Jan 30, 2006 5:07:25 PM

I just saw a 95 year old for a foot problem. Even though it's going to get me docked in the "pay-for-performance" sweeps, her family and I decided not to do any blood tests for her diabetes. Unfortunately, that doesn't happen often; we like active medical care. I thought that I would go insane last week as I gravely listened to the woes of people with colds and tried to explain to them that antibiotics wouldn't help.

OT: Here's an article that appealed to me this morning about one method the French are using to control medical costs:
http://www.lemonde.fr/web/article/0,1-0@2-3226,36-735929@51-725152,0.html

Posted by: J Bean | Jan 30, 2006 5:37:22 PM

One man's rationing-by-income is, under the bastard Calvinism that is our de facto state religion, another man's working out of God's eternal plan, the God who chose him as one of the Elect before the beginning of all time.

Decent health insurance is one of the outward signs of the Elect, and failure to have insurance is one of the hallmarks of the Preterite damned.

Posted by: Davis X. Machina | Jan 30, 2006 9:56:10 PM

OT:

Look at this link: http://news.yahoo.com/s/ap/20060130/ap_on_re_us/state_of_union_kaine

And shudder at how right you were. Once again, our leaders have appointed as their spokesperson someone who will look at the state of the union today and decide that the real problem is those mean Democrats who can't keep a civil tongue in their heads.

Posted by: John | Jan 31, 2006 9:53:25 AM

I propose a five year plan where the smart people will figure out what health care everyone should get. Like the five year economic plans of the Soviet Union I am sure it will be a model of efficiency and fairness.

Posted by: Dave Justus | Jan 31, 2006 2:03:55 PM

I propose a five year plan where the smart people will figure out what health care everyone should get.

Look around, Dave. That is what is happening now.Eaza and his ilk (I just thought that hilarious) are already fomenting your health plan now. And they are the smartest.....just ask them.

Posted by: Fred Jones | Jan 31, 2006 2:39:14 PM

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