• R and R

    • Just a note in the NPR all things considered series on health care.

      The Monday report on the home health care for dying kids that resulted from a Reagan anecdote in 1981 and that now results in severely disabled kids getting lots of Medicaid funding for nurses and aides until the age out at 21 when they are forced in most cases into nursing homes.

      That was a Reagan “bleeding heart” moment that was supposed to save money but created a huge expense by providing care that prevented the normal deaths from limited end of life care for infants and young kids.

      The Tuesday story was about the Life magazine story on real “death panels” where people were picked to live on dialysis by a citizen panel who judged patients with kidney failure as being worth saving with the limited dialysis slots. That resulted in “socialized medicine for an organ” (kidney) that was signed by Nixon and has since ballooned into a huge program.

      In both cases, the problem is the lack of systematic response to the problem, but merely a response to a sob story squeaky wheel. Breast cancer is another. Ryan White and AIDS another.

      While AIDS, cancer, and renal failure are seen as systematic problems, smoking, diet, environment, behavior, genetics, prevention is mostly public education with spot public health responses, and some technology changes like much improved blood screening that are broadly focused to improve all blood product safety. What is lacking is attacking all these problems at the individual level to promote prevention.

      And systematic prevention at the individual level is possible as with cardiovascular and stroke prevention with hypertensive and lipid treatments, that while driven by drug sales is evidence based and includes both behavior and (drug) treatment to reduce costs.

    • Whether we are getting good value for the dollars spent is an important and separate subject from Medicare’s solvency.
      The size of the trust fund has nothing to do with its solvency, either,for the dollars have been loaned to the Treasury and spent on current expenses.
      All the trust fund indicates is the amount of Treasury securities that can be withdrawn without an appropriation.
      However, when these securities are withdrawn, they are paid for like all other governmental expenses, sucjh as battleships.
      The trust fund makes it no easier to pay benefits.
      It simply provides a way to pay for similar expenses, albeit without an appropriation.
      I can provide links, if anyone is interested, to justify my remarks.
      Don Levit