<p>If we end fee for service, indirectly, end of life care costs will decline.</p>
<p>I dont think thats what it shows. </p>
<p>“Last Year” <> End of Life Care</p>
<p>We can now keep you alive for multiple years with terminal conditions. Hence the actual Last Year decreases as a percentage.</p>
<p>Did you know Ariel Sharon is still alive?</p>
<p>and</p>
<p><a href=“http://www.reuters.com/article/2010/10/14/us-care-costs-idUSTRE69C3KY20101014[/url]”>http://www.reuters.com/article/2010/10/14/us-care-costs-idUSTRE69C3KY20101014</a></p>
<p>"End-of-life care costs continue to climb upward</p>
<p>Health care costs at the end of life show no signs of leveling off, according to new research from the United States and Canada published in the Archives of Internal Medicine."</p>
<p>The practical reason why tobacco use is the only lifestyle factor at issue is that it is the only one where (1) use or non-use is bright line, unlike the continuum of diet and exercise, and (2) it is uncontroversial that the health impact is negative even with low or moderate use, unlike alcohol.</p>
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<p>We can hope so. Medical practice is so difficult to change, though.</p>
<p>Michigan’s exchange asks for the DOB of each person insured. I don’t recall asking about tobacco but I’d assume it was asked.</p>
<p>CF, Very difficult. My uncle collapsed at age 89. Doctors tried to put stents in him even though 4 arteries were clogged. He was in the hospital for 5 days. Then he died. He was pretty much dead the first day.</p>
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<p>Are you saying that the dollar I spend now on a patient who will die of cancer in three years counts as an “end of life cost”? I don’t think most people use that definition. There’s no bright line between not yet end of life and end of life, but in my mind, three years before someone dies is outside of even a blurry line.</p>
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<p>Exactly the kind of low-hanging fruit I was talking about. If we eliminate that surgery, nobody is worse off except the heart surgeons.</p>
<p>My cousins couldnt pull the trigger. I could see by the look in their faces that they were in agony over making the decision to pull the plug. </p>
<p>The NY Times today has a good article about the problems in Fla and a Wall St Journal article pn page A4 talks about the technicsl glitches.</p>
<p>In California, when applying for coverage, they ask about tobacco use. I am trying to figure out why people are going to be truthful in answering this question. How are they going to verify the answers? Maybe they will use the NSA to intercept your emails, cell phone calls or spy on you with photographic images from their satellites.</p>
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<p>Depends if you are treating them for the same issue. If they have a couple of strokes that would have killed them 30 years ago and they are now alive in a nursing home for another 5 thats End of Life. </p>
<p>In general I’d suggest that there is an average health care cost per decade of life and it is monotonically increasing after the teens. </p>
<p>So what happens if we have twice as many 90 year olds in the system? Four times as many 80 year olds?</p>
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<p>Because the insurance company can rescind your insurance if you lie. Suppose you lie, and say you don’t smoke. Then you get diagnosed with lung cancer, and your record states clearly that you are a two pack a day smoker. Oops… Acme insurance is going to take away your policy for fraud.</p>
<p>Hanna: smoking is not really a bright line. There are smokers who have one cig a day and others who are two pack a day smokers.</p>
<p>I agree that people who require more medical care through no fault of their own should not be charged more. But premiums should not be based on politics. I think the reason the obese are not charged more is that over 50% of the country now are obese.</p>
<p>Your cousins didn’t want to pull the plug, and that is one issue, but it’s not all, or even mostly, on your cousins. The other issue is why the heart surgeons were doing the futile surgery in the first place.</p>
<p>Yeah…</p>
<p>On another note…one reason ACA will work…
Money…</p>
<p><a href=“http://www.nytimes.com/2013/10/11/business/blue-cross-plans-jump-to-an-early-lead.html[/url]”>http://www.nytimes.com/2013/10/11/business/blue-cross-plans-jump-to-an-early-lead.html</a></p>
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<p>And opposite that article is this one:</p>
<p><a href=“http://www.nytimes.com/2013/10/11/us/in-florida-opposition-by-the-state-and-snags-in-signing-up-on-the-web.html?hp&_r=0[/url]”>http://www.nytimes.com/2013/10/11/us/in-florida-opposition-by-the-state-and-snags-in-signing-up-on-the-web.html?hp&_r=0</a></p>
<p>The rosy results are not happening in the 36 states that have federally run exchanges. I find this story discouraging. Imagine wasting all of that time and having no end result! How awful for this woman.</p>
<p>"This week Ms. Cardenas stopped by the Jessie Trice Community Health Center in Hialeah to enroll with the help of a counselor. She needs bladder surgery and insurance. </p>
<p>Error after error popped up on the Web site. So they called the 800 number. An understanding operator on the line said she would personally enter Ms. Cardenas’s information, and that of her family, into the site. That took nearly 90 minutes because of the snags. Suddenly, the 800 operator’s screen went blank; the information had disappeared, not an uncommon occurrence.
The Trice counselor handed Ms. Cardenas an appointment card for December, the earliest she could return because of her work schedule. </p>
<p>“The woman on the phone just told me that everything she put in the system disappeared,” said Ms. Cardenas, who works packaging medical equipment. ‘I lost a day today from work to do this. I am totally frustrated.’"</p>
<p>That’s a very good point, dstark. Much has been made about healthy young men not signing up for insurance. But you know who really really wants healthy young men to sign up for insurance? Insurance companies. I wouldn’t be surprised to see insurers making an aggressive push with advertising.</p>
<p>“Suddenly, the 800 operator’s screen went blank”</p>
<p>That worries me. they should probably start creating files and loading them instead.</p>
<p>This is a multi-year deal. Problems the first week are not going to decide if ACA is a success.</p>
<p>CF, I have been told that some insurance companies are going to show a physical presence in the areas where they want to recruit applicants. Since this person is actually working with the insurance companies on ACA, and she told me awhile back the insurance companies see ACA as an opportunity, I find opinions like projecting only 2 million people are going to sign up a little off. ;)</p>
<p>Six out of ten people can pay less than $100 a month…</p>
<p>[First</a> details released of Obamacare plans in Texas - Houston Chronicle](<a href=“First details released of Obamacare plans in Texas”>First details released of Obamacare plans in Texas)</p>