Monday, November 19, 2012

MEDICARE

There are currently about 48 million people enrolled in the government-run comprehensive Medicare program covering people 65 years and older, at a projected annual 2012 cost of $585 billion, equivalent to $12,200 per person enrolled.

Overall annual health care expenditures in the United States are approximately $2.7 trillion, or $8,600 per capita.  It would be only logical to accept that health care costs per individual for the elderly would be more expensive than for the population at large, but the statistics hide some startling facts compiled by the Health Care Financing Administration (HCFA).

40 percent of Medicare dollars cover care for people in their last month of life, at an annual cost of $234 billion.  If we add people in the last two months of life we are looking at a cost in excess of $300 billion.

Furthermore, 10 percent of Medicare beneficiaries account for 70 percent of program spending, which is equivalent to $85,300 per beneficiary.

Thus, the cost of covering the remaining 90 percent of beneficiaries is actually a surprisingly low $4,100 per person given the age group in question, less than half the per capita cost for the population at large.

From this we may allow ourselves to draw some conclusions:

(1) In terms of the famously expensive United States health care system, government-run Medicare turns out to be not only comparatively cost efficient.  It is also a program universally loved by the country's elderly, yours truly being among them.

(2) It makes no sense whatsoever to try saving program costs by increasing the age of eligibility, because it is not generally at this lower end that the larger expenditures occur.  In addition, it would throw people in the 65 - 70 age bracket onto the mercy and good graces of the private for-profit health insurance industry.  And you can imagine the premium cost at that age.  That is, if you were lucky enough to be accepted.

(3) The problem lies squarely in the end-of-life-care decisions a society makes, and this is not unique to the United States.  The medical community of my native Norway is debating whether, and how, to place monetary restraints on end-of-life care, an issue which the country's politicians are not eager to embrace.  We need only recall Sarah Palin's "Death Panels".

We talk of the health care industry's mission to save lives as if life was eternal, while all one can hope for is to prolong a life.  In the overwhelming number of cases this is a sacred mission, but not indiscriminately and under any circumstance.

Placing value on human life is humanly impossible, so in the end common sense and humility must prevail.

When my time comes I wish to go gracefully, at the least possible expense to my family and the community at large.