How Medicare Wastes Money
Here is what researchers have found both useless and harmful, according to leading medical journals:
- Feeding tubes, which can cause infections, nausea and vomiting, rarely prolong life. People with dementia often react with agitation, including pulling out the tubes, and then are either sedated or restrained.
- Abdominal and gall bladder surgery and joint replacements, for those who rank poorly on a scale that measures frailty, lead to complications, repeat hospital stays and placement in nursing homes.
- Tight glycemic control for Type 2 diabetes, present in 1 of 4 people over 65, often requires 8 to 10 years before it helps prevent blindness, kidney disease or amputations. Without enough time to reap the benefits, the elderly endure needless dietary limits and needle sticks.
More from the New York Times.
It is difficult to categorize medical procedures into two neat binomial columns for Waste / Beneficial. Medical interventions are continuous variables (that vary from one person to the next). If there is even a 1% chance of something being beneficial, both doctors and patients often feel the procedure is warranted. If seniors had to pay part of the bill from a Health IRA, they might have frank discussions about whether a procedure is actually worth the money and risk.
Feeding tubes don’t prolong life because people with dementia pull them out? What about for stroke patients who can’t swallow but who don’t have dementia and can live years after their stroke?
As Devon points out, this is a binomial classification unsuited for the basic nature of medical care. Rather than take these choices out of the public arena by moving to a system of medical savings accounts, articles like this seek to turn people against select life saving procedures by denying them to people who don’t meet government standards.
It isn’t hard to see why it is being presented this way and where the people doing it hope to drive the argument.
One more comment about the assumption that the frailty index performs as advertised. Drame, Novella et al. looked at the predictive ability of four clinical frailty indexes to predict one-year rapid decline, institutional admission, and mortality.
The conclusion? “These findings confirm the poor clinimetric properties of these current indexes to measure frailty, underlining the fact that further work is needed to develop a better and more widely-accepted definition of frailty and therefore a better understanding of its pathophysiolgy.”