Death Panels III – Medicare Boogalee

Tom Price, Tangerine Nightmare’s pick for secretary of Health & Human Services is the a member of a medical organization I’ve written about in the past called the American Association of Physicians & Surgeons. When they aren’t scaremongering about foreigners bringing deadly diseases to the U.S. or complaining about laws that impinge on their ability to discriminate against patients, they’re carping about the horrors of outsiders who interfere with the doctor/payment relationship, i.e. health insurance carriers.

The AAPS thinks health insurance is very bad because insurers have rules that providers have to follow if they want to get paid. But Medicare is the worst because it is health insurance by the government. Better replace it with health savings accounts. Which are administered by health insurance plans, but are acceptable to libertarians who properly translate Increased consumer responsibility to Someone might get fucked over real bad, har har.

Senior citizens, don’t be fooled. The federal government asserts that Medicare sets a high bar for medical care and we are lucky to have it. Not so. It does, however, claim a virtual monopoly on health insurance coverage for all eligible persons.

You only think Medicare is any good old persons, but it isn’t, because this person told you so. Still not convinced? Well, did you know Medicare may be trying to kiiillllll you? Kiiiiiilllllll. Here’s an oversimplified explanation of the hospice benefit that omits some key facts to prove it.

Enter the Medicare hospice benefit in 1982. Policymakers believed this program would lower costs by reducing “aggressive” end-of-life treatments. With hospice care, Medicare pays a daily rate for services to persons with life expectancies of 6 months or less who choose to forgo life-saving or potentially curative treatment for the presumed terminal illness and related conditions.

But Medicare hospice expenditures are rising. Realistically, it isn’t easy to predict who will live and who will die and when. Not only has the number of Medicare hospice patients with not immediately terminal conditions such as heart failure and dementia dramatically increased, 19 percent of such patients receive services for much longer than 6 months.

Pointing to the fact that doctors have certified non-terminal patients for hospice and saying the problem is Medicare is like pointing to the fact that people fib on their taxes and saying the problem is the IRS. In other words, the usual sloppy sleight of hand from the sort of people who really hate the idea of government because it stands between them and the potential victims of whatever scam they’ve got going.

Also not mentioned – hospice is 100% voluntary and the patient may change his mind at any time. In addition Medicare regs allow for the fact that the six month prognosis is the doctor’s best guess. At any rate, prepare for another non sequitur.

The renewed focus on Medicare cost containment has produced various suggestions, including vouchers, tax credits, extending income-based premiums, increasing the eligibility age, and allowing contributions to HSAs in retirement.

Expanding HSAs presents the best opportunity to regain real choice and control over our medical care consistent with one’s personal values.

One thing that the HSA cheerleaders never mention is that the other part of the deal is a high deductible health plan, because that doesn’t sound like much fun. Kill the government types don’t like to talk about it either, because the IRS is heavily involved in the process and they’ve primed their following to shoot a gallon of foam from their mouths whenever the dread letters of that name are mentioned.

The other thing they won’t mention are findings that point to the fact that the impact HDHP/HSAs have on patient care is the wrong one. If one cares about patients, especially elderly ones. If the goal is for them to get sicker, stay sick and die, it could be a good thing.

What researchers found is that high-deductible plans may be working against better health outcomes for patients who need care the most. As the number of chronic conditions increased for each patient with a high-deductible plan, so did that patient’s level of debt and likelihood of delaying or forgoing health care. Just 9 percent of patients with a high-deductible plan and no chronic conditions chose to delay or forgo care, but among those with three or more chronic conditions, 25 percent delayed or went without care.

[…]

Researchers found that 52 percent of patients with high-deductible plans who had three or more chronic conditions reported carrying medical debt, compared with 28 percent of patients with these plans who had no chronic conditions. Among patients with three or more chronic conditions, 56 percent reported their annual out-of-pocket costs exceeded $2,000.

According to the latest data from CMS, 66% of Medicare patients have two or more chronic conditions. People shouldn’t think about that. The AAPSers want them to think about deaaaaath, deaaaaaaaaath. A particular kind of death. That is, death when Medicare is paying for care.

Instead, a culture of hastening death has gradually evolved, disguised as “death with dignity.” First, California, Colorado, Oregon, Washington, Montana, and Vermont have legal physician-assisted suicide, with 20 other states considering legalization.

Assisted suicide has nothing to do with Medicare’s hospice benefit. If it were covered by Medicare it would, like hospice, be at the patient’s discretion. But one way people like Singleton show what they really think of the people they allegedly want to help is by lying to them and making Wooo-woooo! noises to frighten them.

Second, when older folks fall ill, despite the uncertainty of medical prognosis, some families feel they are not merely offered hospice as a choice but are steered toward it.

I live in a state where a doctor got eight years because he stuck cardiac stents in patients who didn’t need them. I have yet to hear anyone suggest we need to stop cardiologists from performing the procedure because of this dude. Neither have I heard anyone say HSAs will stop doctors from performing unnecessary procedures. Although I hear the paperwork can be annoying, collections are a pain and I guess if a patient can’t afford it, the bent doctor will go pick on someone with regular coverage.

Third, disturbing news articles report hospice treatment plans for those who aren’t dying fast enough: “pain management” in terminal doses.

Sounds like the real problem is health care providers. Let’s outlaw them and go back to good old fashioned prayer.