NYT: Cut Medicare, Help Patients

[ABQCOWBOY]

http://www.nytimes.com/2011/08/23/opinion/cut-medicare-help-patients.html?_r=3&pagewanted=2&ref=todayspaper

Cut Medicare, Help Patients

By EZEKIEL J. EMANUEL and JEFFREY B. LIEBMAN

Published: August 22, 2011

MEDICARE is going to be cut. That is inevitable. There is no way to solve the nation’s long-term debt problem without reducing the growth rate of federal health care spending. The only question is whether the cuts will be smart ones. Smart cuts eliminate spending on medical tests, treatments and procedures that don’t work — or that cost significantly more than other treatments while delivering no better health outcomes.

Click On The Link Above To Read The Entire Article...............

[Larry]

Love this idea. In fact, I seem to recall that Obamacare created a group who's assigned duties was to find such savings.

I recall them being referred to as "death panels".

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Anecdotal, but I remember reading about a study somebody did, where they looked at patients who have undergone common life-extension medical procedures, and compared their survival rates over the following five years, against patients for whom the procedure was recommended, but the patient declined. And for several procedures, the survival rate of people who had the procedure, was the same as people who didn't have it. Having the procedure had no statistical impact on the patient's life expectancy.

now, they pointed out that in many cases, the patient who had "Procedure X", but who died, anyway, died of some cause other than what the procedure treated. People, say, had colon polyps removed, and then died of a heart attack a year later, to invent an example. They had a procedure, and then died from some other thing.

The one specific thing I remember from the articles about the study was that, of the people in the "had coronary bypass, but died anyway" group was that, of the ones who died, more than half of them died from an infection that they got while they were in the hospital.

[PeterMP]

The The United States Preventive Services Task Force are the people that recomended that women talk to their doctor about getting a mammogram at 40 instead of automatically getting one. Essentially, everybody on this board threw a fit and acted like it was the worse thing ever.

They didn't even say that every woman in the country shouldn't get one at 40. They simply said that women should actually have a conversation with their doctor about the risk/reward.

[Larry]

And we wouldn't want people to talk to their doctor about end of life planning.

[RLeVan]

It's not the talking to the doctor that's the problem. It's the over the top preventative prescription medication at high prices. That and the baby boomers trying to live forever. haha

[PeterMP]

I wanted to make two other points:

1. The USPSTF isn't really for NOBODY getting colonoscopies when they are older. "The USPSTF recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient." So you have to get to 85 before they recommend against it so it isn't outrageous that medicare would pay for it. The big thing the USPSTF is against is cookie cutter medicine. Everybody isn't the same so they shouldn't be treated the same. The problem is not just the general public, but many doctors like cookie cutter medicine. It is easy, fast, and essentially "mistake" free. It is much easier to say, okay, you're 40, you need a mammogram every year from now until the end of your life. It is harder to go through the risk factors and say okay, are you over weight, did you smoke or did you ever smoke, are menopausal, is there any history of breast cancer in your family, what is your race/ethnicity, do you drink, how much do you drink, what kind of breast do you have, etc.

And then say, you know you're 40, but it doesn't make much sense to do a mammogram. Let's wait until next year.

In addition, if next year when you do the mammogram, you find out the person has/had cancer, then you have to deal with having made a "mistake". And not just the legal implications, but the personal/concious issues too.

It is even harder after giving somebody a mammogram every year for 30 years to say, you know it probably doesn't make much sense to give you that mammogram this year.

2. The other thing this piece makes, but not directly, is why market based reform will fail for healthcare. Free market only works when it is a "good" market, which requires that people make good decisions, but that's not the case w/ healthcare. The piece talks about avastin, but let's even get away from the costs associated with it. If somebody gave you a pill and said take this would you do it. Probably not, but people do it w/ respect to their doctor all of the time. If somebody gave you a pill and said take this, but it isn't likely to positively affect your health, and potentially will have a negative affect (which is the case with avastin) would you do it. Probably not, but people do that with medication all of the time where they don't actually know the benefit/risk because their doctor told them to take it. Then there are even more complex situations where people do things that don't make sense (e.g. Pill A will positively affect your health. Pill B has some of the same stuff as pill A so that component will positively affect your health, but it also has X in it, and studies show that X doesn't positively affect your health and might have some negative affects on your health. Which would you take? I think most people would take pill A, but there are a lot of people in that situation that are taking pill B because that is what their doctor prescribed for them.).

[Baculus]

Some of these cuts wouldn't be necessary if private Medicare practitioners weren't ripping off the system. and hopefully the ACA ("ObamaCare") will reduce such corruption.

---------- Post added August-24th-2011 at 02:00 PM ----------

And we wouldn't want people to talk to their doctor about end of life planning.

Death panels!

[ABQCOWBOY]

The left crucifies the right, claiming that they are trying to kill Medicaid/Medicare yet this very article outlines exactly the same thing for Medicare. How can the left claim, on one hand that the right is trying to drive Seniors off a cliff and propose this in the next breath?

All of this is too political. Unless the right party suggest it, it's wrong. Same with the proposed raising of taxes thread. This is crazy.

[Baculus]

The left crucifies the right, claiming that they are trying to kill Medicaid/Medicare yet this very article outlines exactly the same thing for Medicare. How can the left claim, on one hand that the right is trying to drive Seniors off a cliff and propose this in the next breath?

All of this is too political. Unless the right party suggest it, it's wrong. Same with the proposed raising of taxes thread. This is crazy.

Because the Right have a long history of opposing Medicare and wanting to abolish it. This is well known and well documented. Even more so, Medicare is a single-payer system, which is the sort of program which the right-wing claims will lead to "socialism" (as Reagan said on a record).

Democrats want to preserve and protect (and expand) Medicare -- the GOP want to end it, period, along with other federal safety net programs such as Social Security, Medicaid, etc. But they'll lie about that objective once they're in front of the "wrong" audience, which are seniors. The GOP really don't care about the wellness of seniors -- they just want their votes.

[ABQCOWBOY]

Because the Right have a long history of opposing Medicare and wanting to abolish it. This is well known and well documented. Even more so, Medicare is a single-payer system, which is the sort of program which the right-wing claims will lead to "socialism" (as Reagan said on a record).

Democrats want to preserve and protect (and expand) Medicare -- the GOP want to end it, period, along with other federal safety net programs such as Social Security, Medicaid, etc. But they'll lie about that objective once they're in front of the "wrong" audience, which are seniors. The GOP really don't care about the wellness of seniors -- they just want their votes.

Right, which is why Bush gets crapped on by the Left for expanding the program right? At some point, you have to actually look at what is going on. What it looks like to me is people taking sides and falling in line along party talking points. We gotta stop this. This is madness. Gotta start thinking for ourselves. I don't agree I guess.

[PeterMP]

The left crucifies the right, claiming that they are trying to kill Medicaid/Medicare yet this very article outlines exactly the same thing for Medicare. How can the left claim, on one hand that the right is trying to drive Seniors off a cliff and propose this in the next breath?

All of this is too political. Unless the right party suggest it, it's wrong. Same with the proposed raising of taxes thread. This is crazy.

How is this killing medicare?

Mostly it is about making good decisions, and in many times, not even making good decisions as a function of costs, but in terms of good healthcare.

[Baculus]

Right, which is why Bush gets crapped on by the Left for expanding the program right?

Like this?

"In his new budget, to be unveiled Monday, President Bush will call for large cuts in the growth of Medicare, far exceeding what he proposed last year, and he will again seek major savings in Medicaid, according to administration officials and budget documents."

http://www.nytimes.com/2008/01/31/washington/31budget.html

Bush did create and expand the drug benefits program, but it came with criticisms, especially since saw saw the bill as a gift to Big Pharm, especially due to a lack of price controls and reform in the bill.

I do believe Bush had some good intentions in his effort, and I believe W. was a bit more "progressive" compared to his current counter-parts, which is also why Bush is reviled by some on the Right. Of course, it's all relative.

At some point, you have to actually look at what is going on. What it looks like to me is people taking sides and falling in line along party talking points. We gotta stop this. This is madness. Gotta start thinking for ourselves. I don't agree I guess.

Yes, it is madness that you are willfully perpetuating the Republican deceit in this issue. Consequently, you DO have to look at what's going on, but you're not. You are, in essence, denying a well-known GOP objective, "taking sides and falling in line along party talking points," and it is strange that you are doing so, considering this statement.

Conduct your research and quit listening to baloney GOP talking points. Here is a hint: Google "republicans eliminate medicare." Feed your mind.

[ABQCOWBOY]

How is this killing medicare?

Mostly it is about making good decisions, and in many times, not even making good decisions as a function of costs, but in terms of good healthcare.

The initial piece posted is about cutting Medicare. It goes on to explain it as "good decisions" but I ask you honestly, if this were a piece posted by Fox or somebody, would the rhetoric the piece received not be along the lines of trying to push Grandma off a cliff? Both parties have proposed pieces similar to this. It is my observation that these kinds of suggestions are meet with cheers or curses depending on what party has suggested them.

[PeterMP]

The initial piece posted is about cutting Medicare. It goes on to explain it as "good decisions" but I ask you honestly, if this were a piece posted by Fox or somebody, would the rhetoric the piece received not be along the lines of trying to push Grandma off a cliff? Both parties have proposed pieces similar to this. It is my observation that these kinds of suggestions are meet with cheers or curses depending on what party has suggested them.

I can't speak for anybody else, but my response would have been the same. I have no problem w/ cutting Medicare, especially in a manner that isn't likely going to affect health out comes at all.

I've talked about the problems with cookie cutter medicine here more than once.

**EDIT**

Oh, and I'm pretty sure that Larry has posted that story about the medical costs here before too.

[mcsluggo]

The left crucifies the right, claiming that they are trying to kill Medicaid/Medicare yet this very article outlines exactly the same thing for Medicare. How can the left claim, on one hand that the right is trying to drive Seniors off a cliff and propose this in the next breath?

All of this is too political. Unless the right party suggest it, it's wrong. Same with the proposed raising of taxes thread. This is crazy.

there is a lot of truth to this.... but there is also a real and viable difference, as well.

Republicans would be able to discuss restructuring the military to a leaner (smaller) size without generating nearly the uproar that would ensue if Democrats proposed the same plan.... and it happens because the military stakeholders feel that the GOP has built up credibility inthe area that the Dems don't have. THey would better believe that that a GOP plan would have the long term-viability of teh military at heart, and would be more willing to listen to the propasal.

Same story (reversed) for say welfare reform. Dems have better credibility that reforms would be aimed at streainling rather than gutting a welfare system.

A very stark (and exagerated) version of this occurred when i first moved to California, my FIRST election there was a ballot initiative called something to the effect of: "the strengthen California's smoking laws and reduce teen nicotine addiction " initiative. Right before the the election it was revealed that RJR had sposored the initiative (through a labyrinth of 50 or so shell companies). Should voters have trusted that initiative?

details matter.

[ABQCOWBOY]

I can't speak for anybody else, but my response would have been the same. I have no problem w/ cutting Medicare, especially in a manner that isn't likely going to affect health out comes at all.

I've talked about the problems with cookie cutter medicine here more than once.

I have never known you to lie to me Peter (maybe disagree but not lie) so I have to believe that what you say here is true. I wish there were more like you on both sides.

[Jumbo]

I have never known you to lie to me Peter (maybe disagree but not lie) so I have to believe that what you say here is true. I wish there were more like you on both sides.

There are more than few people here of different sides that I wish were more common to the larger scene of political discourse. But maybe there are, and we just get a disproportionate helping of the others via various media due to the nature of the beast(s).

[Larry]

There are more than few people here of different sides that I wish were more common to the larger scene of political discourse. But maybe there are, and we just get a disproportionate helping of the others via various media due to the nature of the beast(s).

Uh, from what I've seen of other venues, ES's representation of wingnuts is disproportionately small.

(Although some of them do compensate for their small numbers with posting volume.)

[Jumbo]

Uh, from what I've seen of other venues, ES's representation of wingnuts is disproportionately small.

(Although some of them do compensate for their small numbers with posting volume.)

The "uh" and even what follows makes me think you may not have understood. My comment was a compliment paid to said posters, and I was also adding a hopeful/positive spin that the rest of the national political landscape may not be as bad as it seems.

[Larry]

Well, we can't expect the population as a whole to rise to the level of the average Redskins fan.

[PeterMP]

Well, we can't expect the population as a whole to rise to the level of the average Redskins fan.

I think that's obvious. For example, despite the claims of twa about the educational system in TX, it can't be good or there wouldn't be any Cowboys fans.

---------- Post added August-24th-2011 at 05:08 PM ----------

I have never known you to lie to me Peter (maybe disagree but not lie) so I have to believe that what you say here is true. I wish there were more like you on both sides.

From 2009:

http://www.extremeskins.com/showthread.php?297619-Economist-The-politics-of-death

BUT assuming it was Medicare, you can easily argue that the government probably SHOULD NOT have paid for his care.

Nobody doubts that Medicare is going broke. It CAN NOT afford to continue to cover care in the manner that it has historically based on the monies it bring in.

My problem w/ government medical care is EXACTLY opposite of most other people. I think it does (where it exist) and will continue to do a bad job of saying NO, but SOMEBODY (and normally not people that can vote or are even alive) are going to have to pay.

Also in the same thread:

I'm also remembering reading about a study that was done, tracking the life expectancy of patients who had received certain types of very popular medical procedures, and comparing their life expectancies against patients whose doctors recommended those procedures, but who chose not to have them.

And in a lot of cases, the people who had, say, angioplasty, didn't live any longer that the people whose doctors recommended angioplasty, but the patient declined.

One result that really stuck in my mind was that people who had heart bypass surgery actually had shorter life expectancy than the people who didn't have it.

Although it was also pointed out that, of the people who were treated for condition X didn't die of condition X, (that the procedure did prevent the thing that they were trying to prevent), they died of something else, instead.

That, for example, of the folks who had heart bypass surgery, but died within 5 years, anyway, very few of them died of heart attacks. In fact, more than half of them died from infections which they got while they were in the hospital.

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Should Medicare pay for heart bypass surgery, if the statistics say that the people who receive it don't live any longer than without it?

Agreed. The only alternative is "we'll pay for whatever the Doctor recommends".

Which does have some merit. After all, he's the "man on the ground" who actually knows the patient's circumstances, and is trained in what the options are.

But do you really expect the Doctor to not, say, send somebody in for a bypass, if there's a slight chance that it might work?

(Although that's why I do think that, if we go with the "panel", that it should be partially, if not entirely, restricted to Doctors. I think I'd go so far as to say "Doctors who have never held elective office".)

I think if you read that thread it is clear that Larry and I both believed, at the time that Obamacare was being discussed, that there has to be away to limit expenses and taking the doctor of the patient might not be the best way.

Ideally, we need a doctors on the ground to make good medical decisions, but there is plenty of evidence that they don't. We need to have some sort of sight system to check doctors.

**EDIT**

I wanted to add that Baculus has grown (well depending on your perspective grown might not be the right word) more than anybody else here in my time. I think some of us have "moved", including myself and Bang, but I think that "movement" has also been due to the "movement" of the Republican party. I think we've moved less than the Republican party.

But Baculus used to be a pretty hard core libertarian. When somebody accuses of Baculus of being a non-thinking partisian hack (or the equivalent there of), it rings hollow to me. People of that nature don't make the change that Baculus has very often, and my initial thought is the person that is doing the accusing is almost certainly reflecting their image onto him.