Jonathansmith9 2008-03-26 11:58:26
I always thought this to be an interesting statistic. I’ve seen the
numbers bantered about that 50% of what we spend on health care we
spend in the last 6 months of life. I have no doubt that this is
true. I always wondered, though, how you could change that since when
you start spending the money, you don’t know IF it is the last six
months of that persons life. We do know, that in some situations
failure to spend on health does ensure that it will be the last six months of life.
If he said that he is full of c***. Dialysis is not a rationed
service in the UK – it is an inconvenient one. We did a thing with
the NHS quite a few years ago – tender procurement of dialyzers.
First hand knowledge. Lots of older folks on dialysis for quite a few
years we were told. Did you know that the NHS has portable dialyzers?
But it did interest me to see what amp may have said (since I’ve been
compared with him). Google does a pretty good job and this is what I
found from about a year or so ago.
“…If you are over 65 in the UK, your chance for a renal transplant
are next to nothing.”
Guess he was talking about transplants, not dialysis and age 65 not
55. But then again, it took me all of 2 minutes to find the quote.
I’d argue against that, being retired and all. My portfolio of
investments still generates a lot of economic horsepower and taxes.
I once saw an economist make that argument with differential equations
– very exquisite math but the audience was a bit besides themselves with the implications.
And the solution, therefore, for the inevitable budget busting SP is
to limit access to care. The Europeans seem not to have an issue with
it – so should we? And as I pointed out, it is the core to the JAMA
authors argument. Save money on administration and limit supply.
Works for the Brits (except for the adminsitrative cost savings part,
anyway). if you want SP according to the JAMA design – you better
learn to live with rationing.
Founding fathe 2008-03-27 13:21:01
It’s sort of like the observation that we always find a lost object in the
last place we look. 🙂
Would it be gauche of me to point out your portfolio will continue to
“generate a lot of economic horsepower and taxes” even after you die? 🙂
I think the proper solution is to abolish all inheritance taxes, BUT take
out of the estate all money spent by Medicare or any other tax funded source
before it’s distributed. Then the person can decide whether she wants to
spend the money to hang around a few more months (which may be a perfectly
reasonable choice) or to leave the extra few hundred thousand to the
grandkids, cats, charity, whatever. That way the person is making the
decision with her own money, not someone else’s.
And that is the fundamental principle essential to any reform of health care
that will work.
Hrubin 2008-03-29 23:53:58
There are short-term heroic measures and long-term ones.
Sometimes the short-term ones can lead to long-term costs,
but it can be very difficult to decide when to do what. A
brain tumor operation can fail to remove the problem, but
this is not likely to be known, and there can be months of
hospitalization during which the patient may believe in
recovery, although those who know do not, and is fully
conscious, but dying nonetheless. These are in my opinion
the worst, not the ones who are in a vegetative state, or
who are feeling pain. The worst I experienced for a close
relative was the years my father was bedridden after a stroke,
and could not realize why he could not get up and be fully active.
I have seen many of my friends and relatives die. That figure
is not likely to be the case unless often; it was not the case
for any for whom I have reasonable information.
This uses recent techniques. My late sister was on dialysis for
years, and doing it at home would have been far too difficult.
It was expensive then, and at least it was claimed that the UK
had an age limit on it.
Is “in many cases” enough to deny it? Suppose in 10% of the
cases this is true, but the more typical term is 10 years or
more. My sister was not the best of candidates for medical
treatment, and she lived on the order of that length of time,
being a full participant in family activities except when
receiving the treatments.
This address is for information only. I do not claim that these views
are those of the Statistics Department or of Purdue University.
Herman Rubin, Department of Statistics, Purdue University
email@example.com Phone: (765)494-6054 FAX: (765)494-0558