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Going Geriatricidal

Bruce Krasting's picture




 

 

Naked Capitalism featured a piece today by Matt Stoller (Link). The not so surprising conclusion by Matt was that moving the age for Medicare availability from 65 to 67 will actually cost some lives. The article concludes that the two-year change in federal medical coverage will result in 1,261 additional deaths each year.

 

I’m reading this, thinking, “Hey, that’s not so bad!” Matt saw it differently:

 

Or we could leave things as they are, with a Medicare age at 65, and no extra seniors need die.

 
I'm not sure that Stoller is right about this. I wish he were, but the numbers say he's wrong. The fact is, hard choice have to be made, and yes, people will die as a result. The article fails to analyze the benefits of moving the Medicare puzzle around. Fortunately, the Congressional Budget Office (CBO) answered this question back in January (Link). The conclusion:

 

CBO estimates that raising the Medicare eligibility age from 65 to 67 would reduce federal Medicare outlays, net of premiums and other offsetting receipts, by $148 billion from 2012 through 2021.

 

Take the two estimates together, total Early Exiters (EEs) over ten years = 12,610. This means the overall savings comes to a very tidy $11.7m per EE. A big bang for the buck, so to speak.

 

When Congress raises the age limit for Medicare (this will happen in 2013) it will be the first step on what will prove to be a very slippery slope. There has been much talk about a dreaded "Death Panel" that will decide who "Wins" and who "Loses". Changing Medicare age availability is a Death Panel decision. It's interesting/fitting that a majority of Congress and the President will kick the process off.

The CBO should do some more studies on potential savings. Sort of roll up their sleeves and have a look, as it were. I wonder what the savings might be if some new "rules" were adopted. On the list might be:

 

-No new knees or hips after age 85.

-No open heart surgery for men over 82. (Forget about that triple bi-pass that will keep you around another five years.) Women would be eligible up to 85. (Think of the pissing match that would cause)

-A diagnosis of late stage Alzheimer's gets one on a fast track to "Hospice Care". (No meds, palliative only. Door to door, so to speak, averages three weeks)

 

This subject will be on the front page for the next year while the Medicare "fix" is tossed around. After that, it will come up regularly when other ways to "save" a few bil. are found. I figure someone has to make some black humor from this, I might as well start now. Before you toss a brick my way, consider that I'm 62 and in four years, I will be a real player on this stage. Who knows? I might even become an EE'er. This joke is on me.

 

 

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Fri, 12/14/2012 - 12:57 | 3062993 flacorps
flacorps's picture

Here's how to reduce health care expenses: refuse to pay more than it's worth. Pay $4,200 on an $11k claim, in-network or not. It's called an accord and satisfaction check.

http://creditboards.com/forums/index.php?s=fa6ae5b2dd093c252c3379a730db6...

Fri, 12/14/2012 - 03:31 | 3062025 IQ 101
IQ 101's picture

Death on the installment plan ? no thanks !

http://www.youtube.com/watch?v=hiQoq-wqZxg

Fri, 12/14/2012 - 00:57 | 3061939 Kreditanstalt
Kreditanstalt's picture

No one dies from triaging medical care.  People die from letting themselves become dependent on government care.

Fri, 12/14/2012 - 00:35 | 3061919 sgorem
sgorem's picture

What really gets your blood boiling is the fact that part of the taxes I, and you pay, goes to keeping the assholes in DC alive and well for another day. What a waste of oxygen.

Fri, 12/14/2012 - 00:23 | 3061908 chump666
chump666's picture

I love Bruce's graff photo's.

Orly,

Check this:

*1 Yr USD/CNY forwards spike to day's highs at  1100 pips

China's peoples buyup USDs to offset the inflation/stagflation self destruct?  Other rumor was a huge Brazilian USD order against the Real. 

Wars baby, wars...

 

Fri, 12/14/2012 - 00:18 | 3061897 Orly
Orly's picture

Watch the USDJPY pair here.  It is making a giant cup-with-handle formation on the Weekly from the highs of March 2012.  When it retraces, it will most likely trade down to ~82.4 and possibly as low as 81 before reversing to retest the top of the cup.

It should take several weeks to complete the pattern.

:D

Thu, 12/13/2012 - 23:49 | 3061859 t0mmyBerg
t0mmyBerg's picture

the medical tragedy of the affordable care act is suggested here (never mind the political tragedy of putting the nail in the coffin of the idea of limited federal government).  The tenor of this piece is that health care is static.  The idea behind abominacare is that there are these best practices and we just all do that.  Medical science is still in its infancy.  The span of quality life has been pushed far forward in the last 100 years but has barely left the starting line.  Take a look at the Methusela Foundation http://www.mprize.org/

The idea is that there are ways to push human lifespans much further, with high quality of life.  Obamacare puts much medical progress in jeopardy.  The real tragedy is that life spans will actually start to decline within a generation because the incentives will be all screwed up by the fist of government.  The world peaked in 2000.  It is downhill from here as we have a generation or more of moving left.

as far as raising the age being somehow unfair or leading to deaths, well pshaw.  The entitlement programs, having been designed by government, were designed with little foresight.  The element involving age should have been indexed for lifespan from the start.  Government does most things poorly.  The more government does, the moar that will be done poorly.  People never learn, and if they learn today, they are being taught by doctrinaire leftists and progressives.  Get ready for soft slavery, not to plantation owners but to the state.

Thu, 12/13/2012 - 23:12 | 3061776 Zer0head
Zer0head's picture

It comes down to your genes and access to greens.

Fri, 12/14/2012 - 00:10 | 3061890 Tijuana Donkey Show
Tijuana Donkey Show's picture

That's right! Eat greens every day, and you'll live longer. Ditch gluten, HFCS, sugar, and you can be a beast at 65. 

Thu, 12/13/2012 - 22:38 | 3061704 just_askin
just_askin's picture

Wow, $148 billion over 10 years! Or, in other words, about 0.7% of the net worth of the oligarchs that have been looting the economy for the past 30 years. Better to thin the herd a bit than than to thin the balance sheets of those doing God's work.

Thu, 12/13/2012 - 22:36 | 3061701 americanspirit
americanspirit's picture

How about not a means test but a merit test. When faced with a costly medical decision you get to go before a panel ( chosen like a jury) and argue whether or not society should spend the money to keep you alive. Have you lived your live in a way that contributes to others? Did you wear your helmet when riding your motorcycle at 100 mph? Have you ever been convicted of molesting a child.Are you a rapist? A murderer? A banker? A politician? A crooked cop? Have you lived your life shopping at the mall? Are you a certified asshole. Have you exploited others. Have you made those around you suffer because you are a psychotic jerk. Have you eaten way more than your share? The list could be a long one, but the end result would be that unless you can convince a jury of your peers that your life is worth spending society's money on, tough luck.

Thu, 12/13/2012 - 23:52 | 3061864 Harbanger
Harbanger's picture

Obamacare is just a form of Medicare health insurance for everyone.

Thu, 12/13/2012 - 23:20 | 3061791 Orly
Orly's picture

Kinda hard to do on a vent and a Diprovan drip.  Jus' sayin'.

Thu, 12/13/2012 - 22:29 | 3061673 regionswork
regionswork's picture

The final solution takes shape.

Don't tell your folks you want them to have the good sense to die quickly; they might take you out of the will.

Age 30 might be a good cut-off.

This scenario was given in 1976: http://en.wikipedia.org/wiki/Logan's_Run_(film)

 

 

Thu, 12/13/2012 - 22:17 | 3061638 Yes_Questions
Yes_Questions's picture

 

 

Banksey pic?

Thu, 12/13/2012 - 22:16 | 3061633 Pemaquid
Pemaquid's picture

You might be 62, Bruce, but my guess is you won't need Medicare. Financially, that is.

Sat, 12/15/2012 - 11:34 | 3066224 Bob Sacamano
Bob Sacamano's picture

So those who don't need it or just don't want it should not have to pay for it.  Seems fair.   Unless it is suppose to be a form of welfare for the elderly. 

Thu, 12/13/2012 - 22:12 | 3061622 Fish Gone Bad
Fish Gone Bad's picture

I wonder what people are really owed.  I am thinking "nothing".  Anything that is given away for free is squandered. 

Thu, 12/13/2012 - 21:50 | 3061538 flacorps
flacorps's picture

What about when adult children are on the hook http://www.fromjumpstreet.com/?p=148

Thu, 12/13/2012 - 21:41 | 3061524 Mediocritas
Mediocritas's picture

I don't like the term "Death Panel". What do we call the Triage nurse in an Emergency department? The Black Widow?

Limited resources to support healthcare being allocated to those most in need. It's the same thing: triage. Never a nice thing, but unavoidable. Existing triage systems have evolved over a century of medical care, we already know where the weaknesses are, so that's all that has to be protected against (elevation of ranking due to bribery or relationship).

Thu, 12/13/2012 - 22:59 | 3061749 Orly
Orly's picture

I'll continue to say that the real problem is with the shrouded insurance company/medical reimbursement complex.  If people actually knew what they were paying for services, they would not be pleased.  That's at least half of the problem.

For instance, why should it cost $90,000 to replace a knee?  The titanium is probably $500 bucks, the screws another $100.  A room in the hospital, how much is that?

Once we break down and itemise how much each thing costs, it becomes clear that there is no real reason for a knee replacement to cost $90,000.  Before we go denying grammy any care, how 'bout we reform the way services are billed, starting with seeing the light of day!?

:D

Fri, 12/14/2012 - 12:06 | 3062797 blunderdog
blunderdog's picture

    why should it cost $90,000 to replace a knee?  The titanium is probably $500 bucks, the screws another $100.  A room in the hospital, how much is that?

We should get illegal aliens doing the surgeries.  That'd save on labor.

Obviously, if the Mexicans are good enough to take over the construction industry, there's nothing keeping them from installing body-parts.  Why waste big bucks on shit like education and experience?  A floor's a floor, a knee's a knee.

You go first, Orly.

Sat, 12/15/2012 - 11:27 | 3066209 Bob Sacamano
Bob Sacamano's picture

Why should oil cost $90 a barrel.  Why should iphones cost so much?  Why does gold cost so much?  Doesn't silver only cost $5 to mine?  We need a small group of super smart people to set the price of everything -- they will know what's best and fair for everyone.  That is what Obamacare is trying to do with healthcare. Those who love and trust massive govenment will agree, others will be fearful. 

Fri, 12/14/2012 - 12:40 | 3062929 Orly
Orly's picture

You don't understand what I am saying, apparently.  Let me be clear: (Ha!)

I am not denying BioMet and Synthes their money.  The parts should have some reasonably high mark-up.  I don't think anyone having knee surgery would say, "OMG!  Three thousand for the part!"  We all realise that these things cost money to research and develop.

What I am saying is the point the gentleman brought up earlier and that about extraneous, additional and superfluous costs associated with delivering that care.  I bet that $15,000 went to rent the OR Suite for four hours and is charged by the hospital.  That's crazy.

I realise, too, that the hospital has to make money somewhere to make up for people who don't pay anything and get all the services for free.  But that situation is not fair to a paying customer and they know it.  Time and again, you call the hospital and say you want itemisation and the price suddenly changes in your favour.

Here's another example that I have seen a thousand times.  Have some tinnitus, go to the doctor and he orders an MRI Brain/IAC without then with contrast material.  The insurance pays it and they bill the company $3500 ( or usually what the insurance company has already "negotiated" for with the clinic...).

Now go in with the same valid doctor's order and say you don't have insurance but you want the cash price.  The office manager will do some math and come back with a cash price of $1100.  Happens.  All.  The.  Time.

How is that okay?

Fri, 12/14/2012 - 13:32 | 3063103 blunderdog
blunderdog's picture

I don't consider it "OK," but it's certainly to be *expected* in a system of government-provided health-insurance and government-restricted licensing.

Businesses who have gotten the Feds to "lock out" the competition have pulled off all kinds of shenanigans.  You can't start a "private" police department, and you can't just hang out a sign and call yourself a "doctor" and start treating patients, either.

In places where you CAN just hang out a sign and be a doctor, treatment's a lot less expensive.  In places where the government doesn't provide insurance to millions of people, there's less opportunity for the "billable hours" scam you bring up now.

There are some downsides to opening the market of providing medical services to everyone, though, just as there are downsides to the massive administrative expenses of running a health-insurance program and a licensure process.

Fri, 12/14/2012 - 05:43 | 3062074 Mediocritas
Mediocritas's picture

You'll get no argument from me Orly. US healthcare costs are 400%* higher than the OECD average yet healthcare outcomes are nowhere near 400% better than average. US "sickcare" has been completely captured by pharma and Wall St.

*Don't quote me on the 400%, I'm drunk. Have to check the official stats again to be sure.

Fri, 12/14/2012 - 02:00 | 3061974 PlausibleDenial
PlausibleDenial's picture

My girlfriend had surgery for a thyroid tumor.  She eventually got a bill for $5,600.  She had already paid a ton of money due to a high deductible.  When she showed me the bill, I told her to call the hospital and ask for a itemized bill.  Within literally ten minutes the hospital staff came back to her and told her she only owed $600 +/-.  I did then ask her for a blow job for my excellant advice.  That was about 4 months ago and I am still out a BJ.   Damn that traffic jam.... 

Fri, 12/14/2012 - 00:13 | 3061895 sgorem
sgorem's picture

Orly, +1000. The most sensable post on here today, bravo.......

Thu, 12/13/2012 - 21:27 | 3061495 Forbes
Forbes's picture

Get the government out of the healthcare business all together--then it's no longer a political issue of one size fits all (which it doesn't). When you mandate community rating (actuarial socialism), coverage of pre-existing conditions (must-issue policies), coverage through employment (non-portable), deductible business expense (individual policies far, far more expensive), then the so-called unintended consequences are not so unintended. The consequences are cross-subsidies to those less healthy and over-consumption due to the subsidies, and distortions caused by third-party payors (reckless free lunch when someone else foots the bill). Also, much of Obamacare is in reality pre-paid healthcare, and not insurance. The fast, cheap fix is only insurance (major medical, surgical, and hospitalization/accident & emergency) is tax-deductible--by the individual payer, not by business--and long-term policies should be offered in the market (5-,10-, and 20-year policies are offered in Switzerland). Regular and customary (office visits) expense should be paid out of pocket. Healthcare costs rise faster than GDP because the tax-deductibility of regular and customary care is a tax subsidy to healthcare providers. Mandated coverages (NY has 52 mandates) is a further subsidy to higher spending. Politicians telling you how to spend your own money because you don't know any better--what could possibly go wrong?

Thu, 12/13/2012 - 21:16 | 3061464 worbsid
worbsid's picture

Are we ready for Soylent Green yet? 

 I am 79 and in pretty good health but my knees bother me ... not enough to get an operation because OTC pain pills are still working but it looks like it may be time do one in January and another in June.  I should be good to 90 or so.  40K per knee would make it only 8K per year. Why does a metal knee cost $40K? 

Thu, 12/13/2012 - 22:44 | 3061714 blunderdog
blunderdog's picture

       Why does a metal knee cost $40K?

Because the R&D that paid for it was financed a long while back at a fairly high rate of interest.

Since you asked.

Thu, 12/13/2012 - 23:01 | 3061754 Orly
Orly's picture

That's the biggest red herring in medicine.  Yeah, if they weren't reimbursed 5000x on the back end, they wouldn't build it!

Puh-leez...

Fri, 12/14/2012 - 11:58 | 3062777 blunderdog
blunderdog's picture

Eh?  Sounds like you may not know how this stuff works.

The only reason ANY of this technology exists in the first place is because speculative enterpreneurs took a chance by spending millions of dollars (mostly starting back in the '80s) researching how to replace things like joints and organs.  These were risky businesses, because there was never a guarantee they were going to succeed, and they were leveraged to the hilt to do the research.  MOST of the projects FAILED.

Even after developing successful materials and technologies, they had to either license the patents (if applicable) or sell lots of product for DECADES to pay off the initial CapEx that funded the R&D.

This is the way finance is supposed to work.  It makes possible very expensive projects that can't be funded with immediate market demand.

What's MOST IMPORTANT about the whole picture is this: none of this would have happened without Medicare.  There would be no demand at all for $40,000 replacement knees if the government hadn't been subsidizing that development--most folks don't end up needing them, and most folks who DO end up needing them can't afford them.  Enterpreneurs only took the chance in the first place because they knew the Feds would pay to get these new technologies installed into old geezers.

I'm amazed that this stuff is not all recognized around here.  Why did *you* think the USA was the home of so much biomedical technology research?

Sat, 12/15/2012 - 11:13 | 3066194 Bob Sacamano
Bob Sacamano's picture

So the obvious answer is to get government out of old geezer healthcare so they do not pay for all of this new stuff.  Or to have government fund only modest, very basic medical care -- nothing state of the art or expensive.  

Healthcare cost inflation is a myth.  You can get 1980s medical care fairly cheaply today (no MRIs, no CAT scans, very few heart by-passes, etc).  Government can not provide state of the art care for everyone -- it is too expensive.   Hence government will start rationing care via their IPAD committee of unelected bureaucrats determining "best practices" (as they solely define). 

 

Sat, 12/15/2012 - 15:33 | 3066855 blunderdog
blunderdog's picture

       the obvious answer is to get government out of old geezer healthcare

That's what I think.  I believe have to find an entirely different method of delivering health-care (and survival necessities).  One that ISN'T just based on the government sending people checks.

The problem really comes in when you stop focusing on what's *needed* and focus only on *paying* for it.  "Money" is NOT survival or health-care, and it's survival and health-care that we should really concern ourselves with.

Fri, 12/14/2012 - 15:32 | 3063782 Forbes
Forbes's picture

You're part way there... But the assumption that lacking Medicare, no bio-med R&D would exist seems a bit faulty. Presumably an alternative system would exist to pay for old age healthcare. For example, a life insurance policy that annuitizes into healthcare insurance at age 65. Lots of ways to do it without the government putting their nose in it.

Most of the problems in healthcare is that no one competes on price--as if doctors and hospitals are above grubby commerce. Doctors are churned out of medical school performing most procedures and surgeries like so many assembly line widgets--they have to for quality control. Training, real estate, capital equipment, support personnel--hardly different from most complex businesses. They're not performing miracles...

Fri, 12/14/2012 - 15:49 | 3063882 blunderdog
blunderdog's picture

    But the assumption that lacking Medicare, no bio-med R&D would exist seems a bit faulty.

That's not an *assumption,* it's a conclusion, and yes, it's slightly exaggerated.  There will always be SOME level of medical R&D, but it becomes a much more appealing gamble when you know that the unlimited budget of the taxpayer is going to be available to pay for any product successes in a decade or two.

The facts correlate very well.  The USA HAS BEEN the home of the vast majority of the past 50 years worth of "medical breakthroughs," and we pay a lot more for health-care than anywhere else.

Do you see the connection?  We're STILL paying for the stuff that the developers were dreaming of in the '70s.  In other parts of the world, where they are able to pay *only* for the successes, they pay less for everything, and they now have access to a LOT of the same stuff we do as the economy of scale comes into play and stuff can be mass-produced, unlike during the "prototype" period.

Thu, 12/13/2012 - 20:58 | 3061408 kaiserhoff
kaiserhoff's picture

You and I will probably live longer with less medical care, Bruce.

I remember a meta-study of autopsies on men who died from all sorts of conditions, but not cancer.

Almost 70% had some abnormal prostate cells, but had no cancer, and had no reported problems in their medical histories.  If some hack doctor had been monitoring them for "abnormalities" that stuff would have been treated, with all sorts of nasty results. 

Also this, from the Harvard nurses study and subsequent follow-ups:

All professional groups undergo major surgery at about the same rates, except for doctors and nurses, who go under the knife about half as often.  What does that tell you?

Fri, 12/14/2012 - 00:07 | 3061885 SpeakerFTD
SpeakerFTD's picture

Would you happen to have a link to that study?

Thu, 12/13/2012 - 21:01 | 3061420 spinone
spinone's picture

That patients are a profit center.

Thu, 12/13/2012 - 20:31 | 3061327 Body of Lies
Body of Lies's picture

Why can't we just have the healthcare that we can afford ... new knee at 90 for 40,000 ... if I can afford it I want it

Thu, 12/13/2012 - 23:37 | 3061834 lasvegaspersona
lasvegaspersona's picture

25 grand gets you a trip to Thailand's Bramrhumgrad (sp) Hospital with a caretakers and a room nicer than a Vegas suite.....oh you get a hip replacement for that too. American trained orthopod.

Thu, 12/13/2012 - 23:25 | 3061805 Body of Lies
Body of Lies's picture

Great news ... I'll keep the link as a favorite

Thu, 12/13/2012 - 20:26 | 3061309 spinone
spinone's picture

Bruce,

According to this article, 25% of Medicare spending is for the last year of life.  Euthanasia would give significant savings.

http://content.healthaffairs.org/content/20/4/188.full

Thu, 12/13/2012 - 23:33 | 3061825 lasvegaspersona
lasvegaspersona's picture

Why wait, killing stupid people would be even more money saving. In fact lets just kill everyone but you and me and a few politicians (to help our cause) a gaggle of beautiful broads and send the remainder off to die in a war.

The fact that granny paid into a system and was promised lifetime care...eh...just another govt promise to be broken....

Hey lets promise EVERYONE healthcare and then kill them too...we'll just say the money ran out...

Youn think like a politician.

Thu, 12/13/2012 - 21:12 | 3061449 johnQpublic
johnQpublic's picture

there we go spinone

+1

exactly what i was thinking

perhaps pre-emptively at 85 say(easy for me to say, as no male in my family has lived past age 74)

but if i do make it that long, i beg you to just shoot me(assuming wife still alive)

Thu, 12/13/2012 - 20:35 | 3061336 Not Too Important
Not Too Important's picture

Once we see the full effects of all the radiation from Japan in a few years, treatment for most cancers will be struck. Other than mild skin cancer, it'll be bottles of pain meds and straight to hospice. As the pain kicks in, that bottle of pain medicine will look better and better.

There's no way the government - or what's left of the private insurance industry - is going to pay for the waves of lethal radiation cancers coming, and it will be so prevalent they will lump all cancers in the Fuku category. Probably some kind of medical force majure called, to make it all legal.

The radiation is rampaging through the Infant Mortality Rates. We're next.

Thu, 12/13/2012 - 23:42 | 3061847 andrewp111
andrewp111's picture

Once the Mideast has its full blown nuclear war, what you describe might be global and not just in Japan.

Fri, 12/14/2012 - 02:20 | 3061990 Clowns on Acid
Clowns on Acid's picture

Peak Humanity?

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