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January 20, 2012

Another Reason for Rising Health Care Costs?

In an earlier post, we discussed the health care industry's 1 percenters:

When it comes to America's spiraling health care costs, the country's problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country's medical spending.

Of course, health care has its own 1% crisis. In 2009, the top 1% of patients accounted for 21.8% of expenditures.

Of course the high spenders in health care are predominantly elderly. Here's the opposite end of the spectrum:

In the past four and a half decades, the frequency of long-term impairments for newborns who survive complications has remained about the same, according to the research team, which was led by Michael Mwaniki of Kenya Medical Research Institute’s Center for Geographic Medicine Research. The scientists suggest that improved medical technology has “increased survival in neonates who would have otherwise died,” which cancels out advances in treatment for less severe cases.

Even in wealthy countries where health care is widely available, complications during pregnancy increase the odds a child will have a chronic disease later in life. In middle- and lower-income countries, impairment of a child can mean “major burdens on families and societies, and shortened life expectancy,” the authors write.

The common thread here is that advances in medical technology enhance longevity and survival but also increase the proportion of the population with serious (and expensive) medical conditions.

What to do? It is a puzzlement.

Posted by Cassandra at January 20, 2012 07:11 AM

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It's a question of incentives, and so a question of values (and not a matter of government "management" of incentives).

I could not love Caesar less, loved I not Rome more. So it is with where we place our finite resources: there's more research/medical service/medical providers/whathaveyou going into geriatric care than neo-, postnatal, or pediatrics care--or the fruits of those efforts work more efficiently in the geezer population than in the noise-maker population.

Not to discount the political factor: grandma votes; baby doesn't. Even in the totalitarian states--maybe especially there--there's little incentive to take seriously the young relative to the old.

And it's a matter of living longer at both ends of life. We've recognized for some time that geezers now are living long enough to encounter medical problems that didn't used to exist. So it is with babies. ...improved medical technology has “increased survival in neonates who would have otherwise died[.]” As we did with gramps and grams, we need to shift focus on medical research goals with our babies and yout's.

Eric Hines

Posted by: E Hines at January 20, 2012 10:40 AM

The problem is only going to get worse. But, as always, more information (data) is always useful. I read a report last year that the lifetime medical costs of smokers was lower than obese people whose costs were lower than "normal" people. Reason was the earlier ages for dying for smokers and obese, and thus not prolonging the medical costs for another 10 or 20 years.

Related observation: over 50% of health care costs are incurred during the last 6 months of a persons life. The problem is that we just don't know when those 6 months are.

Unrelated observation. So this 90 year old guy goes in to see his doctor, and asks him, "Doc, I don't smoke, drink, or run around with loose women. Will I live to be 100?" The doctor looks at him and says, "Why would you want to?"

Posted by: Rex at January 20, 2012 01:57 PM

WARNING! What follows is sarcasm. If you do not understand the concept of sarcasm, please look up a definition before continuing to use the Internet. Thank you.

Well... clearly the solution is that we take a page from the Spartans and have each and every baby inspected at birth. Bathe them in wine, and if they're too weak, abandon them on the mountainside for the wild animals to tear apart. It's the only way to keep the country strong.

Posted by: MikeD at January 20, 2012 01:58 PM

I guess I wasn't thinking so much of what to do about it in the sense of babies or Grandma as I was thinking that when we plan for future expenses (Medicare, Medicaid budgets, VA budgets, etc.) we tend to use historic data for our projections.

But just as we've seen with Social Security and pensions, it may well be that simply providing the government benefit increases future costs because if these benefits are universal, people live longer.

We're encountering something similar with veterans - many vets survived injuries that would have been a death sentence in previous wars. But the implication is that many more vets will have expensive health conditions going forward.

I'm pretty sure we didn't plan for this and have no empirical way to predict the effect on future budgets because we really don't have any historical data.

In the case of infants surviving who would not have survived, I think maybe we can discuss the impact on the overall health of the species if more people with formerly fatal conditions grow up and pass those conditions on to the next generation... and so on... and so on.

I'm no fan of eugenics. To me, the takeaway here is the impact of unintended consequences.

Posted by: Cassandra at January 20, 2012 02:11 PM

...I was thinking that when we plan for future expenses (Medicare, Medicaid budgets, VA budgets, etc.)....

Step 1 is to remove these things from the Federal budget altogether, and privatize them (maybe not the VA stuff, but I'm biased). Individuals, having their own skin in the game, will do a far better job of budget planning--even for the nebulous futures.

We're encountering something similar with veterans - many vets survived...the implication is that many more vets will have expensive health conditions going forward.

Not so much with Vets. It may still be a net cost, but many of our wounded warriors return to the work force (or would if we had a work force [/snark]) and lead productive lives, in every sense of "productive." In the event, I'm willing to pay that particular premium for folks who've put their bodies on the line so that I can sit here and rant about the evils of the world. Many of our geezers would return to/stay in the work force, too, if the opportunities were there.

...I think maybe we can discuss the impact on the overall health of the species if more [babies] with formerly fatal conditions grow up and pass those conditions on to the next generation....

But medical technology is a two-edged sword. Genetic research--and this applies on both ends of the life spectrum--can generate methods to correct those genetic flaws before reproduction occurs. However. Leaving aside the myriad moral implications of that, a problem that gets very short shrift is the population that lives longer ("normal" human life span, or "maximum," is reputed to be in the neighborhood of 120 years). We need also to plan for the economic, and ecological, implications of a much longer-lived species that breeds as profligately as ours as capable of doing. And plan for the day when we can extend our lifetimes arbitrarily long.

There's a reason every cell on earth presently has its own death programmed into it.

Eric Hines

Posted by: E Hines at January 20, 2012 03:04 PM

I think first we need to stop thinking that death is optional. Before you toss a concrete block at my head, what I mean is that as a society we need to take a deep breath and really start thinking about quality of life versus sheer longevity. Physicians as well as lay people seem programmed to throw lots of expensive technology at problems, "whatever it takes to keep grandma alive" when pallative care and quiet dignity might be better (and less expensive in cash and emotion). I realize that physicians have one eye over their shoulder for the lawyers, but we need (as a society) to say, "OK, is the outcome worth the pain?"

I think a reemphasis on personal responsibility would also help. McDonalds does not force you to eat giant sloppy burgers, folks. And parents need to say "no" more often, too. My $.02 worth.

Posted by: LittleRed1 at January 22, 2012 07:55 PM

I think where we go wrong may be in refusing to admit the consequences of learning how to do expensive new medical stuff, knowing that we're not going to be able to bear living without the new stuff once we know it exists. The consequences are that we're going to have to do without other things in order to pay for the larger role of expensive medicine in our lives. We won't like giving up the other things (bigger houses, separate households for older generations, more restaurants, more travel, more gadgets), but tough. It's either that, or discover and exploit some fabulous new resources to take up the slack by creating a new and unexpected economic boom.

Posted by: Texan99 at January 23, 2012 11:43 AM

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