I don't know what the costs are on a macro level but I can address what is going on with my parents. My Dad died not too long ago and my mom is 90.

They certainly have incurred higher than normal healthcare costs but not what you are suggesting here. Older people just have more minor health issues. Urinary tract infections, pneumonia, broken bones from falls, etc. They aren't life threatening, nor are they things that younger people don't get, they just have them happen more frequently.

I don't really think you can frame this argument like you are framing it. Sure, there are circumstances where elderly people are kept alive when maybe it doesn't make sense. But I don't know that that is the big picture.

BTW, both my parents have/had DNRs. It was pretty evident my father was dying a couple of weeks before he actually died. We never considered putting him in a hospital. We used hospice. I talked to many people during this time that either had gone through this or were caretakers that were relating experiences and this approach seemed to be more common than the "keep alive at all costs" picture that many have.

ZOMG death panels just creates a political football to blunt any meaningful chance at healthcare reform.

Yeah the reality is most people do not want to be alive at an6 cost. There is a real line of suffering where people and their families reach where it is no longer worthwhile. This seems to be a pretty effective tool for managing end of life care.

There can obviously be exceptions, which would most likely be more family driven then the will of the person who is sick but they are rare enough not to be worth hand wringing over.

Also I think a lot of more expensive end of life care needs to be considered research and development. A lot of access, data and studying can come out of those situations leading to new treatments or effective ways to reduce costs on current methods.

Bad idea for a thread but a poster wrote how, instead of paying astronomical medical costs to prolong life, the government should just give them money to travel or do whatever they want with (this is in the US where you could like easily travel around the world for less than the cost of cancer drugs, not sure how it is other places with socialized healthcare). Seemed like a pretty good idea imo. I don't know the overall cost picture but I can attest to seeing some ridiculous things being done first hand to patients with little to no chance of recovery. In any case this belongs in a larger discussion of healthcare costs.

Can I be your slave?

In the not so distant future we will probably have rich people with super immortality drugs who get to live for 150 years while having multiple generations work and die for their profits in their multi national conglomerate corporation. Maybe zombie Reagan will come back for brains, and he and 100 year old Trump will give a state of the world address live on every channel that is really just one channel because Sinclair bought out every station and Ronnie will have brain juice trickling down his cheek and Donny will be lapping it up like a golden retriever. MAGA baby

More likely old people will soon stay in bed but have their brains attached to robots like in the movie Surrogates.

2+2 is a funny place

Hospice has turned out to be more expensive than hospital care. Why? Because humans have gamed it.

One of the biggest expenses is for Alzheimer’s. Which is ironic because the beneficiaries have no clue or care.

OP made this point really poorly, but I think it's pretty debatable that we should be spending hundreds of thousands of dollars to give an 82 year old another 6 months of extremely painful life. We do that literally every day.

In other words I sincerely wish Obamacare had death panels in it. That would actually do something about us spending 18% of our GDP on healthcare at least 6% of which is pure waste.

The only way to lower healthcare costs is to do less somehow. I agree that it should be universal and that a universal system would cut tons of waste (google insurance subrogation... it's a huge industry that is 100% waste)... But we still won't be able to afford giving every Grandma as much treatment as we can pack in before her heart stops on the public dime. It's way way out of control at this point.

And those nursing home stays are INCREDIBLY expensive. We spend 2-3x the median family income on every old person when they get towards the end basically. I suspect that if you offered most of them the money instead of the treatment they'd snap take it and pass it on to their loved ones.

If the people who are getting the treatment wouldn't pay for it if it were up to them I don't see what the hell we're doing here.

I pretty much disagree with most of that. Some of it, though, I'm not sure about.

I have some rambling thoughts here

We have this vision that people at end of life are being artificially kept alive. Although that might be true in some cases, I'm not sure it is the norm. I don't have anything to back this up and I would suspect that you don't have anything to back your thesis up either. But, I sort of believe that the extent of the cost is to simply make someone as comfortable as possible while they are dying, not necessarily to keep them alive longer. I don't have any issue with this. When it hits home for you (i.e. someone close to you is in this situation) I suspect you might not either.

I certainly won't dispute that health care costs go up as people age. My parents certainly got sick more often (pneumonia, urinary tract infections, etc.) but they were treatable and I would argue that these are the same sort of things that occur with younger people, albeit not near as much.

I would also argue that there are a lot of conditions that are very expensive to treat. Cancer comes to mind. Where do we draw the line? What about someone young that is given a 10% chance of surviving? 50%? How do we make these decisions?

I would also argue that a significant percentage of health care goes towards people that simply don't live a healthy lifestyle. Smoking, obesity, etc. My gf is an occupational therapist that works in home health care - covered my medicaid. Although she has many elderly patients, she also has a large number of younger (40s, 50s) that have diabetes related complications, drug addiction related complications and just general unhealthy lifestyle complications.

I certainly used to have your viewpoint about societal costs. I've changed my view here. It seems to me absurd that corporations sit on trillions of dollars, money is funneled to the ultra wealthy, and we spend most of our money on defense and yet we can't afford basic healthcare for every person in our country. It hurts my brain to think of this. How can we consider ourselves the greatest country in the world if we can't take care of our sick?

I would agree with you on the waste. This is a solvable problem. I don't think we ever eliminate it but incrementally we can deal with it. It's a problem worth working on but not a problem that should prevent everyone access to basic healthcare.

For some actual data on this, here's an academic paper on this subject:

The Myth Regarding the High Cost of End-Of-Life Care

Good share T50. I am pretty conflicted on this subject and that article sheds a lot of light on the issues.

While those stats indicate that end of life costs are not a huge part of the medical costs overall, they show that most people will end up having a costly end of life. So, if you're medical insurance isn't solid all the way until you die or unless you have a lot of money, medical costs will probably end up making die broke.

Yeah... any academic study that doesn't show that end of life costs (the last 1-5 years depending on how long it takes for your final illness to kill you.. this means I'm lumping all alzheimers patients into 'end of life care') are where most of our lifetime health spend goes for the average person have been cooked somehow.

Here's what I know anecdotally, and unfortunately I have a large sample size because of who I am, who I'm related to, who I'm married to, AND where I live... (son of someone whose end of life expenses were literally 5x his lifetime expenses up to that point who is also a health insurance agent who sold medigap and medicare part C plans, an actuary, a nurse, Louisville KY which means I know a lot of people who work at Kindred and Humana)

We spend an ungodly amount of money on the people in nursing homes, the majority of which are deeply unhappy and in the (hopefully!) last years of life. When I say ungodly I do mean ungodly. 15-20k a month isn't remotely uncommon including pharma costs. Most spend 50-100k right at the end on a combination of pharma, surgery, and about a hundred other things that could magically get not included or allocated differently in a study.

One of the important things to realize about health care statistics is that nobody knows anything. The paperwork is so complex that there is a call center located <50 miles from me that pays hundreds of people 50-75k a year to help their clients subrogate their insurance claims. This means that there are hundreds of mid level employees whose entire job is to figure out how to get someone else to pay for the claims.

When there are enough legalities, fine print, and designed complexity (and medical billing is nothing if not intentionally misleading) it becomes possible to make the data say anything you want.

Every other country in the world has universal healthcare, which means medical rationing. When the conservatives go on and on about waiting lists that isn't actually made up. Thing is, maybe those waiting lists are a feature and not a bug?

Bottom line is my dad got a 150k surgery 2 months before he died. He got the surgery so that he would qualify for a chance at a clinical trial. There was no chance the surgery was going to save his life or anything, it just gave him a 50/50 chance of getting a trial which game him a 2-5% chance of living an extra year. Anybody who tells me that wasn't a normal experience in our healthcare system hasn't worked in a nursing home (my wife did for 5-6 years).

lol

/thread I guess.

Im with you all the way Bored, I think there should be death panels and public dollars should not be used much to prolong old sick peoples lives. If someone wants to burn their own money keeping themselves alive then so be it. But dont waste other peoples money on it.

Your dad potentially getting in a clinical trial that has potential to lead to some sort of breakthrough has some real and substantial value.

Improving end of life care and pursuing it ultimately creates a potentially greater quality of life for a substantial portion of time. I mean people used to often be on deaths door at 40. Should we have just said, we’ll its way to expensive to try and take care of people over thirty five so let’s just blade runner them.

And the reality is there are real cost issues now in terms of what hospitals charge. It’s entirely possible the similar surgery could have randomly cost between 25k to 500k depending on which hospital just because hospitals often literally just charge whatever.

Until we are able to attack that it doesn’t even make sense to determine how much is REALLY being required to be spent on end of life care because we do not actually know.

You are right on nursing home care. It is absurd. A couple years ago we had to deal with both my parents being in nursing homes and you were pretty much looking at 7k-15k a month just for basic living in a rundown facility in an undertrained and understaffed facility.

Medicaid pays for this for most people but there are some weird cracks. If someone has the assets they have to pay themselves. You can spend down and use trusts and other devices to get there but like with my dad the fact that his social security was maxed out meant it was impossible for him to qualify for Medicaid coverage for staying in a nursing home.

We have a whole different discussion that needs to be had about how we are caring for and managing our elderly but it unfortunately doesn’t come first. I basically cared for both my parents by myself for awhile. My mom didn’t really get bad until the last couple of years but my dad had advanced dementia that required extreme attention for about ten years before they died. Honestly physically and mentally it was extremly difficult. Eventually it became too much though and we had to look at other options. My mom got really sick which triggered a series of events where both my parents died about a month a part in 2016. They only had minimal time in nursing homes but I still struggle with that as I still don’t know if I could have coped with them living that way.

Again though this is all cart before the horse stuff now. We already have enough resources to cover how people are being treated now and that includes significant overpayments. We have to sort out the basics of health coverage before we can deal with end of life care at all.

Assisted suicide should be legal everywhere, but lol at convincing anyone who doesn’t want to die and their family to let you push grandma off the cliff.

You might have an easier time promoting a thunderdome where anyone who has enough societal infraction points has to fight against each other for survival. Every 100k in unpaid medical bills, felonies, deadbeat fathers, high school drop outs, traffic accidents, all add to your point total and enough gets you an invite you can’t refuse to play on live tv. 10% that survive get their points reset to zero.

Basically agree with BoredSocial's posts ITT, but there are huge obstacles to any sort of change. One is the extent of denial of death of most of the human race, but the other is practical. I'd be on board with giving terminally ill people some money to go do fun stuff instead of getting expensive and pointless treatments, but any sort of financial incentive for their children immediately runs into the problem of kids trying to off their parents to get that sweet money.

Yeah my issue with Obamacare started and ended with the fact that it did exactly nothing for cost control... And cost control is our big problem in healthcare.

I'm always amazed that people can't see this when I tell them that our Healthcare spend as a % of GDP is ~18% and the nearest competitor is at 12% with an older population.

But because we're Americans and this is American politics we've spent the last 20+ years squabbling over who will pick up the check rather than having a riot about the size of that check.

Something has to give. It's one thing to do deficit spending on stuff like education, infrastructure, and basic science that generate solid returns (in future taxes)... But wasted money we have to pay back in the future is still wasted money. Waste is never a good thing, and as I get older I see it more and more as one of the few profoundly evil things. Right up there with dishonesty (we would all be better off if we could stop lying but it's baked into human nature IMO) and violence (which in its best form is just one person stopping someone else from being violent by using violence on them).

EDIT: So the good news is that the right answer to health care isn't in who pays for it, but in the bill being that high to begin with. Nobody cares who pays for lots of stuff because they don't cost that much. Healthcare will pretty much always cost 10%+ of GDP so who pays for it will always be important... but right now our big problem is getting it down 6%. 6% of US GDP is a LOT of money. Vastly more money than we spend on poverty programs. More than we spend on the military. It's also the primary driver of the deficit. Our economic problems would be vastly improved if we could use that money on literally anything else.