<p>The fact that a relatively few people account for most health costs is not surprising, it is the basis in fact of how group health care plans of any kind work, that the big cost risk is spread over a lot of people, thus a younger, healthy person pays into the system and uses very little, while an older or chronically ill person uses a lot more. It is one of the reason the idea of people buying their own insurance is problematic, because to an insurance company that is a pool of 1 person (they don’t look at all their policies as a group plan, in other words) and you pay for it (last I checked, if you tried to get a family plan on your own here in the NYC region, it was in the mid 25k range…). </p>
<p>One of the problem with medicare is because it represents a group composed of relatively high risk people, older people, so the costs tend to be higher, and even though everyone pays into it through payroll taxes because the payees are all likely to have more health costs it isn’t the same as a group plan would (in other words, the beneficiaries are a lot more likely to need expensive care then members of a standard group plan). </p>
<p>Containing costs in health care is difficult because it is very unique and you run into moral issues not found elsewhere. For example, you have someone with severe dementia and they go into cardiac arrest and they don’t have a DNR order, so you revive them, at a cost of as much as 100k…does that make sense? If someone is in advanced cancer, do you continue expensive chemo and radiation or do you make them comfortable in hospice care? And do you force people to make those choices? Likewise, if doctors allowed real competition, would you shop around for the lowest price on a heart bypass or would you look for the best doctor/hospital you could? I see this all the time, there are cut rate laser eye centers charging like 400 bucks an eye, but would you trust your eyes to a cut rate place that works on volume? </p>
<p>One of the biggest problems we face with our health care system IMO is that it treats disease, rather then prevents it, a lot of the most expensive diseases are lifestyle ones, things like obesity, smoking, pollution, bad nutrition, stress all play a role in why people get major diseases but very little is spent on prevention, other then things like the food pyramid and the like. Government subsidies in the food industry tend to do the opposite of promoting good health, for example, subsidies for the corn growers and agribusinesses makes high fructose corn syrup dirt cheap and it is used as filler in a range of processed foods many people eat; likewise, meat is subsidized for the producers, and it means cheap, fatty fast foods and processed foods, there is a lot more support for that kind of food then towards getting healthy options on people’s plates or making more healthy food as convenient and cheap as the fast/processed food many people eat.</p>
<p>And this shows with the older population, one of the problems is that while people are living longer, thanks to modern medicine, the quality of the older years are not necessarily keeping up. I know this sounds horrible (and it is), but thanks to modern medicine people who would have died off in their 60’s and 70’s a couple of generations ago keep on living into their 80’s, but the problem is those last couple of decades are full of expensive medical intervention and other services like nursing homes, rather then representing someone active and moving about. People talk about raising the retirement age as the population has gotten older, but in reality how many people are healthy enough to keep working into their 70’s? How many by the time the hit retirement age of 65 are already health challenged? Again, I realize it is a horrible thing to say, but is extending life like that when someone is basically not leading a productive life or able to function a good thing?
Think about the Terri Schiavo case, where she was basically kept alive artificially, requiring constant medical support that is expensive, where her brain was basically reduced to a brain stem, what do you do then?</p>
<p>Again, I am not giving answers to these questions, I am pointing out some of the fundamental questions we have to ask ourselves about medical care, and despite what some pundits say, it isn’t easy. Free market health insurance won’t solve this alone or at all, because part of the problem is how medicine itself is practiced, and there are real questions that are horrible to answer, about when do you step back and let nature take its course and when is it worth keeping going? </p>
<p>My point is to highlight something I figured out 30+ years ago when I was debating health care policy in High School as part of a debate team, that there are no simple answers or solutions to the problem, health insurance is part of the problem, but it is only 1 part of it and most of the solutions to health care I see fail to address basic issues of the cost of health care and so forth.</p>