So many topics and issues have been suggested by various emails. Personal experience, however, prompts today's item.
The movie 'Moneyball' makes direct reference to the baseball analyst Bill James. James created what is now called sabermetrics, the statistical analysis of baseball. While numbers such as batting average and slugging average, earned run average and winning percentage had been around for many years, they did not explain or describe the game's variations. James became motivated by listening to the pronouncements of 'baseball men'. These included things like 'pitching is 90% of the game' or 'he's a complete player'. James started asking in a numerical way if pitching was really 90% of the game, and sabermetrics had its birth.
This item is not about baseball, but James' efforts to understand the game by numerical analysis appealed to me as an approach, and is a reflection of an approach to life. We need data, not platitudes, to try and understand our experience, and to form our values. Among James' data driven conclusions was that signing an older superstar player to a high dollar contract was always a mistake. James developed a way to value players, and then looked at how a player's value changes over time. The peak years of performance are from 25 until 32. After 32, all players's performance and value decline substantially. In the case of an outstanding player this deterioration will not be immediately apparent. His ability is so high that even its decline leaves a quality player. It just does not leave a player worth 20,30 40 or 50 million dollars over 5 years. Without question, absolutely, positively, investing big money in players over 32 is a waste of money. Teams get a better result every time if they will use that same money to sign and develop younger players.
This is relevant to health care. 2.5 million Americans live in nursing homes or assisted living. At an average daily bed cost of 234.00 and 365 days this is a cost of 214 billion dollars for bed and board alone. Hospitalization costs have to be added, as well as medications and physician and other provider visits to these institutionalized adults.
The question must be asked: what do these adults provide in return? I am not asking about those elderly who live independently, who interact with their children, who take their grandchildren for walks, and so forth. I am asking about institutionalized adults. Many of these can not walk, have limited speech, do not recognize their children, are incontinent. What do these individuals contribute to society, to their families, to themselves? If we grant that life has some existential meaning greater than death, and so avoid the error of the Nazis, who killed for the assumed good of the State, the question remains of what good is created by these institutionally dependent adults.
I assert that nothing is created or achieved by the ongoing existence of these adults. For those who say their families are better off with their relatives alive in such a setting I say in return, show me how. If your aged relative is better off, if you are better, your family is better, then do as the Japanese do, and bring these honored relatives into your homes, where you may provide care for them and honor them yourselves. Nothing whatever prevents this. You may choose who provides the care, and perhaps accept the smaller home or lesser car that the loss of income from elderly care requires.
I assert that our current system achieves nothing. Buildings called nursing homes and assisted living are filled with elderly individuals much as personal storage unites are filled with household goods that are excess and forgotten, but which we can not quite throw away. Our elderly are not honored. Their care is foisted off on paid strangers, giving us the sop that we care while not interfering with our efforts to earn more money or live yet more luxuriously. To the extent that their care is paid for by the State, we have a perfect example of private benefit being paid for by public money. If you want your elderly relative cared for, do it yourself, on your time and money. But do not ask others to do that emotionally and physically hard work, and do not ask the State to pay for it. Do it yourself.
We claim that the health of our nation is improved by Federal healthcare, and that one measure is life expectancy. Who among us wants to end our lives in assisted living or a nursing home? What have we accomplished by prolonging life that is not productive and not independent? What have we purchased when we do a carotid endarterectomy or an aortic aneurysm repair on a person over 65 (or 70 if you prefer)? We say we have purchased more time for that person to be with their family, to contribute to their personal or familial emotional wellbeing.
But that is a private benefit, usually purchased with Medicare, a publicly funded entity. Again the conflict of private good being bought with public funds. But what we really have purchased with our elaborate healthcare for the elderly is a greater chance for them to become institutionally dependent, incapable, destitute and ultimately a forgotten and forgettable burden. For if they are not that, why do we not bring them into our homes?
I assert we have bought neither a public or a private benefit. We have instead, in the guise of kindness, sidestepped out own fear of death. If we were not afraid of death, we would not treat so frantically and vigorously those with otherwise terminal illnesses in their 70s.
This is why I feel we can best reduce Federal expenditures on medicare not by decreasing payments, and not by creating an increased deficit with the annual 'doctor fix'. We can best reduce Medicare's costs by simply refusing all vascular and cardiac care, all transplants and cancer care, for those over 65 (70 if you prefer). There is precedent for this in the western world (Germany, Singapore). For those who want such care for themselves or their families, let them put their money where their mouth is, and purchase a wraparound private policy for such care, again as is readily purchasable in Germany.
We are like baseball executives who do not pay attention to Bill James' analysis. We invest our public healthcare money in the ineffective care of the elderly rather than in the care of the young. And we sure are paying for it.
Ted Tsaltas
The movie 'Moneyball' makes direct reference to the baseball analyst Bill James. James created what is now called sabermetrics, the statistical analysis of baseball. While numbers such as batting average and slugging average, earned run average and winning percentage had been around for many years, they did not explain or describe the game's variations. James became motivated by listening to the pronouncements of 'baseball men'. These included things like 'pitching is 90% of the game' or 'he's a complete player'. James started asking in a numerical way if pitching was really 90% of the game, and sabermetrics had its birth.
This item is not about baseball, but James' efforts to understand the game by numerical analysis appealed to me as an approach, and is a reflection of an approach to life. We need data, not platitudes, to try and understand our experience, and to form our values. Among James' data driven conclusions was that signing an older superstar player to a high dollar contract was always a mistake. James developed a way to value players, and then looked at how a player's value changes over time. The peak years of performance are from 25 until 32. After 32, all players's performance and value decline substantially. In the case of an outstanding player this deterioration will not be immediately apparent. His ability is so high that even its decline leaves a quality player. It just does not leave a player worth 20,30 40 or 50 million dollars over 5 years. Without question, absolutely, positively, investing big money in players over 32 is a waste of money. Teams get a better result every time if they will use that same money to sign and develop younger players.
This is relevant to health care. 2.5 million Americans live in nursing homes or assisted living. At an average daily bed cost of 234.00 and 365 days this is a cost of 214 billion dollars for bed and board alone. Hospitalization costs have to be added, as well as medications and physician and other provider visits to these institutionalized adults.
The question must be asked: what do these adults provide in return? I am not asking about those elderly who live independently, who interact with their children, who take their grandchildren for walks, and so forth. I am asking about institutionalized adults. Many of these can not walk, have limited speech, do not recognize their children, are incontinent. What do these individuals contribute to society, to their families, to themselves? If we grant that life has some existential meaning greater than death, and so avoid the error of the Nazis, who killed for the assumed good of the State, the question remains of what good is created by these institutionally dependent adults.
I assert that nothing is created or achieved by the ongoing existence of these adults. For those who say their families are better off with their relatives alive in such a setting I say in return, show me how. If your aged relative is better off, if you are better, your family is better, then do as the Japanese do, and bring these honored relatives into your homes, where you may provide care for them and honor them yourselves. Nothing whatever prevents this. You may choose who provides the care, and perhaps accept the smaller home or lesser car that the loss of income from elderly care requires.
I assert that our current system achieves nothing. Buildings called nursing homes and assisted living are filled with elderly individuals much as personal storage unites are filled with household goods that are excess and forgotten, but which we can not quite throw away. Our elderly are not honored. Their care is foisted off on paid strangers, giving us the sop that we care while not interfering with our efforts to earn more money or live yet more luxuriously. To the extent that their care is paid for by the State, we have a perfect example of private benefit being paid for by public money. If you want your elderly relative cared for, do it yourself, on your time and money. But do not ask others to do that emotionally and physically hard work, and do not ask the State to pay for it. Do it yourself.
We claim that the health of our nation is improved by Federal healthcare, and that one measure is life expectancy. Who among us wants to end our lives in assisted living or a nursing home? What have we accomplished by prolonging life that is not productive and not independent? What have we purchased when we do a carotid endarterectomy or an aortic aneurysm repair on a person over 65 (or 70 if you prefer)? We say we have purchased more time for that person to be with their family, to contribute to their personal or familial emotional wellbeing.
But that is a private benefit, usually purchased with Medicare, a publicly funded entity. Again the conflict of private good being bought with public funds. But what we really have purchased with our elaborate healthcare for the elderly is a greater chance for them to become institutionally dependent, incapable, destitute and ultimately a forgotten and forgettable burden. For if they are not that, why do we not bring them into our homes?
I assert we have bought neither a public or a private benefit. We have instead, in the guise of kindness, sidestepped out own fear of death. If we were not afraid of death, we would not treat so frantically and vigorously those with otherwise terminal illnesses in their 70s.
This is why I feel we can best reduce Federal expenditures on medicare not by decreasing payments, and not by creating an increased deficit with the annual 'doctor fix'. We can best reduce Medicare's costs by simply refusing all vascular and cardiac care, all transplants and cancer care, for those over 65 (70 if you prefer). There is precedent for this in the western world (Germany, Singapore). For those who want such care for themselves or their families, let them put their money where their mouth is, and purchase a wraparound private policy for such care, again as is readily purchasable in Germany.
We are like baseball executives who do not pay attention to Bill James' analysis. We invest our public healthcare money in the ineffective care of the elderly rather than in the care of the young. And we sure are paying for it.
Ted Tsaltas
This raises, for me at least, some very difficult questions. You have made some excellent points. We go to great ends to preserve life. We assume that, in many cases, longer is better, though this is clearly not always the case as those watching a loved one decline will attest. This is inevitably a "What is the value of a life?" question. It is tempting to take a primarily utilitarian view, which your solutions do to some degree. If we are to conclude that the aged in poor mental and physical condition do not merit the assistance of the government because they don't contribute to society (or their families) in any meaningful way, we must sure ask the same of the severely disabled, the profoundly mentally handicapped etc. It is true that in some ways we do not honor the elderly as we should, and that to our detriment.
ReplyDeleteCaring the elderly in institutional settings can be a rewarding and meaningful mission, even those who seem to have "outlived their usefulness." It would certainly be ideal if families could keep their elderly at home and care for them there. There was a time when this was the norm, and provided an opportunity for parents to model responsibility for their children. It also connected generations in a way that rarely happens now. I have known families that brought elderly parents home. It was difficult and painful. They sometimes resented the burden. That they did it anyway should be applauded and they would have benefitted from more respect and community support.
In the current economic climate it is especially difficult for families to take on the responsibility of caring for elderly family members. It is all the more so because even young adults fairly new to the work force think they are entitled to all kinds of amenities their parents spent years working for. They aren't even interested in staying home with their own children so it should be no surprise that they are disinclined to care for their elderly. These sacrifices are not applauded. Many assume that things are what give children advantages and make them feel loved. I don't think they could be more wrong!
So, what makes a life valuable? And if we're even going to have that discussion, who gets to decide what "valuable" is? I realize I've offered no solution to the problems you've raised, and those problems are very real. I'm just not comfortable having to define "value" to solve them!
Health Care Rationing means making choices about what to pay for and what not to pay for. We KNOW that a carte blanche is not feasible when it comes to having the government (i.e., our taxes) pay for health care. We HAVE to make cuts. The question is, "Where?"
ReplyDeleteI have heard that in Great Britain the National Health System (NHS) doesn't pay for dialysis after age 60. If your kidneys fail after that age, you either buy your own insurance, pay out of pocket...or do what all of mankind did century after century, millennium after millennium, up until the latter half of the 20th century: die.
We all have to face the Grim Reaper some day, but because of the historically very recent advances in public health and medical care, many moderns seem to think that this translates to an invitation to try to sustain life as long as possible, no matter what the financial costs are. This is not a healthy attitude.
Medicare and Medicaid are going to have to become obligatory rationers of health care if the U.S. ever hopes to make any attempt at stopping the bleeding of debt. As all studies have shown, the amount of health care dollars spent on the last few years of life is out of proportion to other ages. So if rations are going to begin anywhere, it is with the elderly. I therefore agree that we shouldn't be using government money to fund nursing homes. If a family wants to keep their loved one in one, then they should have to pay for it themselves.
Is Congress willing to make this change? It seems necessary, though I have my doubts this reform will pass...
David Graham