“It’s always cheaper to let people die”

September 26, 2017 1:13 PM

What The U.S Can Learn From The NHS About Healthcare Part 1’ - - Part 2 - Libby Watson of The Splinter talks to Martin McKee, professor at the London School of Hygiene and Tropical Medicine and research director of the European Observatory on Health Systems and Policies and Rebecca Givan, an associate professor at the Center for Work and Health at Rutgers University, where she studies privatization in the NHS, labor relations and unions.

Dig deeper into what US Universal single payer might look like with Tim Faust’s A Plan To Win Universal Healthcare (Jacobin) and his new nitty gritty healthcare policy podcast HEAVY MEDICAL (Contains heavy metal).

posted by The Whelk (27 comments total)

Is it always cheaper to let people die? Young people too? Are so few of us more useful to the economy than health services are expensive?
posted by clew at 2:52 PM on September 26, 2017 [4 favorites]

Very interesting that the problems and skyrocketing costs were all introduced by market-based reforms and privatisation.
posted by oheso at 2:56 PM on September 26, 2017 [18 favorites]

Are so few of us more useful to the economy than health services are expensive?

I have a chronic disease, require expensive care, and am definitely a drain on the world when it comes to resources. I contribute but there's no way it overcomes the cost of simply existing as I do.

It's kind of sad to think about but it's very likely that there are very few people (healthy or not) who have a net positive effect on the world.
posted by paulcole at 3:28 PM on September 26, 2017 [9 favorites]

I've met Rebecca Givan!
posted by The Underpants Monster at 4:02 PM on September 26, 2017

So all these health care entities that preserve the life and health of people who aren't a "net positive" would themselves be responsible for a huge drain on the economy, and should perhaps not be paid so much for work of such dubious value to society?
posted by Former Congressional Representative Lenny Lemming at 8:08 PM on September 26, 2017 [2 favorites]

The title is easily refuted: Canadian life expectancy is longer, yet Canada spends less per capital than Americans do on health care. In at least one case it's cheaper to keep people alive, and I suspect this pattern repeats in most of the western world.
posted by simra at 9:00 PM on September 26, 2017 [10 favorites]

Obligatory (hopefully unnecessary) reminder that there's a lot more to having a "net positive effect" on the world than personal financial contribution.

It cost the Canadian government about $1,000,000.00 (in today's money) to get me through my first 90 days of life. There's no way I'm ever paying all that money back in taxes. But, I've had and continue to have a positive effect on the world in other ways, direct and indirect. Hopefully that can be said for most of us.

You don't know when you try to save a life what impact that person's presence or absence will have. It's a gamble, but one worth taking.
posted by Secret Sparrow at 9:10 PM on September 26, 2017 [15 favorites]

Benefits to the world are often diffuse, while costs are acute. It's often noted that mothering a child is an extraordinarily intense job that's given no financial consideration, but what is a society without children being raised?

A lot of financial mechanisms are abstractions and distractions from what's really going on.
posted by effugas at 9:26 PM on September 26, 2017 [8 favorites]

I've met Rebecca Givan!

She’s one of my best friends, I’ve known her since she was in high school. Can’t believe she made the Blue!
posted by schoolgirl report at 9:35 PM on September 26, 2017 [2 favorites]

The fact is that the Medicare population is the population most satisfied with their healthcare in the US, and they have the best outcomes. The only portion of the population that has decent health outcomes in the US compared to other countries is the population that is in Medicare, which is the single payer system.

for an incrementalist (japanese) approach...
Want a Better Health Care System? Check Out Japan; twitter version:

• The Japanese health system is among the world's cheapest. Even cheaper than Britain's!
• And it achieves this low expenditure despite having almost twice as many elderly people (relative to population) as the United States!
• Nevertheless, Japan has a very high quality of treatment - as good as the United States.
• Could this all be due to diet?, you ask. Well, that certainly doesn't hurt:
• But obesity explains only a modest portion of the spending gap between Japan and the U.S.:
• So how does this magical Japanese health care system work? Here's a comprehensive rundown:
• Basically, Japan has govt pay 70% of everything (or more, for poor or chronically ill people). And private insurance pays the other 30%.
• The U.S. could approximate this system by simply extending Medicare - the current Medicare system, not Bernie's thing - to all Americans.
• Japan caps health care prices. But even without price caps, govt can do much the same thing using monopsony bargaining power.
• Meanwhile, high copays - especially a percentage system like Japan's - give the government a fiscal escape route.
• The cool thing about Japan's system is that not only is it the world's best, it's actually not *too* far from what we have now! (end)

posted by kliuless at 10:10 PM on September 26, 2017 [19 favorites]

Is it always cheaper to let people die?

The way I interpreted the statement was: how much do you think the government spent on health care in the 16th century?
posted by um at 11:32 PM on September 26, 2017 [1 favorite]

As a current beneficiary of the Japanese healthcare system, I can heartily recommend it to anyone who can get it in their clutches! I won't be giving it up voluntarily for another few ... well, until I die.

It has its downsides, but they're being addressed, and they're nowhere near the downsides of America's "free market" non-solution.

You can have my Japanese healthcare when you pry it from my cold, dead hands.
posted by oheso at 5:22 AM on September 27, 2017 [5 favorites]

I may have used this Krista Tippett quote before. It's from Becoming Wise.

Meanwhile, we developed too ready and fluent a vocabulary in the blunt metrics of the market, the numbers. I’m stretching my point only a bit when I say that in American life, every vision must begin and end in an economic argument in order to be heard, on urgent matters of human life: labor, education, immigration, refugees, prisons, poverty, health care.

Rename these “issues” in light of what is at stake in human terms, and consider the complex mix of questioning, applied virtue, and yes, political and economic wisdom we need to muster for robust, sustained, generative grappling: the future of human vocation, of how we punish wrongdoing and create space for redemption, how we treat outcasts and strangers and the hungry, how we re-imagine health in a world of ever longer lives, how we nurture our children’s minds and equip them for the world they will navigate and make. We know in our hearts and minds that we are bigger and wilder and more precious than numbers, more complex than any economic outcome or political prescription can describe.

Feels like it's time to stop relying on 'the marketplace' for guidance in health care.
posted by MtDewd at 5:55 AM on September 27, 2017 [9 favorites]

The title is easily refuted: Canadian life expectancy is longer, yet Canada spends less per capital than Americans do on health care. In at least one case it's cheaper to keep people alive, and I suspect this pattern repeats in most of the western world.

Right- but you could spend zero money and let everybody die. It would be free!
posted by cushie at 6:25 AM on September 27, 2017 [4 favorites]

A few years back I could generally see my GP on the same day (I'd probably have to hang around the surgery for a while though, but still not more than a hour or so's wait)... now I have to wait a month. Or phone every morning first thing to try and catch a cancelled appointment.

Also if it's something that's easy to diagnose and treatment is a quick fix/prescription then you're doing alright. If not... well it can't be that serious, eh?

And 'free'... well there's prescription charges, dental charges and no free glasses any more (unless you are a pensioner - who tend to vote tory). If you are poor and cant' afford those.... well here's a mountain of paperwork to go through. Get anything wrong... oh dear, your fault, here's a penalty charge.
posted by fearfulsymmetry at 7:04 AM on September 27, 2017 [1 favorite]

Here is the complete list of WHO | European Observatory on Health Systems and Policies by country. One will need a pdf reader in order to consume reported qualitative and quantitative data and then compare health systems and policies, including financing, by country, for example, UK, FR, UZ.
posted by marycatherine at 8:29 AM on September 27, 2017

Not only would more people with chronic illnesses be out of the workforce as they suffered through what time they had left, but a number of their healthy relatives would also be forced out of the marketplace and into unpaid health and hospice care labor.
posted by The Underpants Monster at 11:50 AM on September 27, 2017 [4 favorites]

That's why I endorse a two-pronged approach: free health care for healthy people and swift euthanization for the unwell. The savings speak for themselves.
posted by Mr.Encyclopedia at 12:26 PM on September 27, 2017 [3 favorites]

how much do you think the government spent on health care in the 16th century?

In Europe, possibly more than they spent on anything but wars and harbors, although in most places it was through church rule as well as secular government. Most religious foundations had hospitals and quite a lot of them were founded entirely to run hospitals. There were also almshouses for people too old to work, which could happen pretty young by our standards.

England had a more secular system after they schismed, with every parish responsible for the care of its citizens, and although a lot of places failed there was a huge investment of money and effort and social responsibility and considerable provision of care. The Webbs' analysis of how it had succeeded, and failed, in a world of increasing mobility, is in no small part responsible for how the NHS finally developed.
posted by clew at 12:33 PM on September 27, 2017 [6 favorites]

... And European hospitals probably got a lot of their practical workings from Islamic ones; and Islamic founders might have known about even earlier public hospitals in India, where they seem to have been (be?) a traditional duty of the Vaishya. Really, "those with means should help take care of the sick and helpless" is not a novel idea.
posted by clew at 12:48 PM on September 27, 2017 [6 favorites]

None of which is actually relevant to the title -- *most* governments exist mostly in a state of debt. (I looked up Canada: yup, carrying national debt, and Harper's balance-book improvement was ginned up by cutting healthcare.) Possibly it takes more hours to take care of the average person than the average person has in their working life, in which case every attempt to do so for everyone will collapse. Good way to go, though.
posted by clew at 2:20 PM on September 27, 2017 [2 favorites]

Leaving health care--and other care work--entirely to the "private sector" is a recipe for setting back women 50 years, which for a lot of the Conservative free-market fundamentalists, is a feature, not a bug.
posted by Kitty Stardust at 5:12 PM on September 27, 2017 [2 favorites]

The quote from the title is used in the context of issues in the NHS that Givan sees as caused by underfunding, not anything to do with the US system:

LW: So why have those decisions—the lack of willingness to allocate the funds—been made in the UK?

RG: I think it has to do with the public budget and unwillingness to spend money, particularly when there’s a sort of general sense in the air that the right thing to do is keep corporate taxes low and incentivize corporations. There’s been an unwillingness to spend money. The general cost of healthcare has gone up as people are living longer and as technology has advanced, so more treatments for more conditions are available, when people would have earlier just died of those treatments. The most cost effective thing to do is always to let everybody die; that’s very very inexpensive, so a society has to decide whether and how much it wants to stop short of that, and what money it’s willing to spend. It’s always cheaper to let as many people die as possible.

Both interviews are interesting and not long.
posted by markr at 5:28 PM on September 27, 2017 [3 favorites]

"Let people die" can and does save vast amounts of money. There is (almost) always some expensive "life saving" treatment that can be tried. Many of them only extend life by days or weeks the vast majority of the time, but the 1 in 10 it gives 6 months or a year or more cause all 10 to give it a go even if it isn't so likely to help.

When these treatments involve $20,000 doses of drugs, well, ain't nobody other than the insurance company who wants to say no, aside perhaps from the patient who has made peace with their fate, even as family hang on to fleeting hope and drug companies and (some) doctors and hospitals wring every dollar possible out of the situation by encouraging expensive and mostly useless treatments long after they would be of enough benefit to justify the cost.

More than anything else except perhaps delayed seeking of care for financial reasons, end of life care is the biggest reason we spend so much on health care in the US. Most other countries don't spend a quarter of a million dollars or more keeping people who were already on death's door alive for an extra week through the use of heroic lifesaving measures on someone who has little to no chance of recovery (for the most part). Mostly not by saying no, by the way, but by being realistic about the benefits, drawbacks, and likely outcomes of the expensive last ditch efforts.

Few people want to put their loved ones through the wringer for little to no gain, but we in the US tend not to get the advice necessary to make an informed decision lest someone be accused of instituting "death panels." Combine that with years of ER and House making it seem like one last million dollar treatment will solve all the patient's problems and let them go home with everything back to normal and you have a recipe for families demanding that patients be saved no matter what the outcome or cost.

While it is true that many uninsured don't get those kinds of options, it's less true than you'd think. A large part of Medicaid's budget goes to paying for that last few days of expensive and ultimately useless treatments of the indigent who die. We can't help them in life, but once they are cold on a slab the hospital submits the paperwork for the eighth time and this time it gets approved since it's solely to the hospital's benefit now. No "icky" perverse incentives here. Except for the ones on the part of the health care industry to spend everything possible so they can make enough on the dead person to help pay for some of the people that can't pay and don't die.

Some of this sounds cold as fook, I know. I tend to come off that way when talking about death for $reasons. Still doesn't change the numbers. Everybody dying only a week earlier than they do otherwise would save literally billions a year, even if you still tried everything possible to save trauma victims, etc. Obviously just letting everybody die isn't a good option, but some amount of triage might be appropriate. Basically, our end of life care, on the whole (there are exceptions that prove the rule) is pretty close to the worst possible for everyone but the people who directly profit from it, and is a large driver of excess cost relative to other countries.
posted by wierdo at 4:15 AM on September 28, 2017 [4 favorites]

swift euthanization for the unwell

I see what you did there, Mr.Encyclopedia.
posted by Beethoven's Sith at 7:47 AM on September 28, 2017 [3 favorites]

Few people want to put their loved ones through the wringer for little to no gain, but we in the US tend not to get the advice necessary to make an informed decision lest someone be accused of instituting "death panels." . . .

Some of this sounds cold as fook, I know. I tend to come off that way when talking about death for $reasons.

The thing is, this is one of the very few areas where the interests of basic humanity AND the cold hard interest of saving $$$ by the millions happen to exactly coincide.

Hell, I'd ***PAY*** millions to ****AVOID**** that type of unnecessary misery at the end of life.

And I've said this a thousand times before if I've said it once, by the eye-blistering irony of the whole "death panels" kerfluffle is that the entire purpose of the provision that the right-wingnut press killed by raising death panels as an issue, was exactly to AVOID the EXISTING death-panel system that we currently have.

That is to say, the provision didn't CREATE death panels, it ELIMINATED them!

It took decisions that are currently made by a fairly mindless system with a LOT of inertia moving in one inexorable and dysfunctional direction, and put them back in the hands of the patient and the family, where they belong.

But, just TRY to explain that simple fact to anyone . . .
posted by flug at 10:24 AM on September 28, 2017 [4 favorites]

This State Has the Best Health Care in America - "When it comes to living a long life, Hawaii is the place to be. Beyond the beaches, idyllic balmy weather and laid-back vibe, the state also has, it turns out, the most efficient health-care system in the U.S."
posted by kliuless at 9:09 PM on October 3, 2017 [1 favorite]