• Better, if not cheaper

    Ezeliel Emanuel has a great piece over at the NYT about end-of-life care. He starts off by correcting a few myths:

    Here are the real numbers. The roughly 6 percent of Medicare patients who die each year do make up a large proportion of Medicare costs: 27 to 30 percent. But this figure has not changed significantly in decades. And the total number of Americans, not just older people, who die every year — less than 1 percent of the population — account for much less of total health care spending, just 10 to 12 percent.

    While obviously higher than average, these numbers obviously aren’t driving the massive over-spending we do on health care. Plus, what can we do about it? It’s easy to identify the year before people die when we look back at data. It’s impossible to do so looking forward. We spend money on people when they get sick. Sometimes we save them, and sometimes we don’t. We can’t tell ahead of time which group is which in order to save spending by not bothering.

    Besides, we’re never going to do that. Nor should we.

    Emanuel spends the rest of the piece discussing how we could do a better job of end-of life care. But what pleases me most is that he spends his time discussing how we could make it better, not cheaper. Go read it. The stuff he recommends is somewhat common sense, but all-too-often ignored. Death panels even make an appearance.

    If nothing else, it’s nice that one of the first things I read this year acknowledged that sometimes good things cost money.


    • so, if we can’t cut their care, it still leaves us with these two options: we pay more or the medical industry gets less. If we are to ask the median person to pay more, remember that the median worker in America makes about 26k a year and the median household makes around 51k a year. When I tell people those figures they say they can’t be true: how does half of America live on such small sums? Do they have anything more to give?

    • I would have liked to have seen the citation for Dr, Emanual’s figures, however they are consistent with the literature. Steven Cohen and William also found that those in the last year of life do not comprise the majority of high spenders::

      “In 2002, the top 5 percent of the population accounted for 49 percent of health care expenditures. Among those individuals ranked in the top 5 percent of the health care expenditure distribution, 34.0 percent retained this ranking with respect to their 2003 health care expenditures. Similarly, the top 10 percent of the population accounted for 64 percent of overall health care expenditures in 2002, and 41.8 percent of this subgroup retained this top decile ranking with respect to their 2003 health care expenditures. The data also indicate that a small percentage of the individuals in the top percentiles in 2002 had expenditures for only one year because they died, were institutionalized, or were otherwise ineligible for the survey in the subsequent year.”

      “The Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2002–2003” (May 2006)