Category: Seniors

Why Torture Patients at the End of Life?

We wouldn’t do it to a pet. So why do it to mom and dad? Here is a doctor’s plea:

[W]ithout a realistic, tactile sense of how much a worn-out elderly patient is suffering, it’s easy for patients and families to keep insisting on more tests, more medications, more procedures. … When their loved one does die, family members can tell themselves, “We did everything we could for Mom.” … At a certain stage of life, aggressive medical treatment can become sanctioned torture. When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. … A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people anymore.”

Full Washington Post editorial via Robin Hanson.

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Feb 22, 2012 | 4 comments | by

Is Grandma Getting Too Much Health Care?

Valid data show that surgeries on older patients are successful. A 2003 study in the Journal of the American College of Cardiology followed 220 patients age 65 and older who underwent heart-valve surgery. The study concluded that “age does not appear to limit the health related quality of life benefits” of surgery. Even patients over 75 had symptom relief and improvements in quality of life “on a par with improvements seen in younger patients.”

The California study, published in February in the Annals of Internal Medicine, found higher death rates from pneumonia, congestive heart failure, stroke, gastrointestinal hemorrhage and hip fractures at low-spending hospitals. The study’s authors calculated that 13,813 California patients treated for these conditions between 2004 and 2008 would have survived had they been treated at higher-spending ones hospitals rather than low-spending ones.

The Pennsylvania study produced similar results, showing higher survival rates at higher-spending hospitals.

See full article on The Wall Street Journal. Full study here.

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Nov 15, 2011 | 3 comments | by

War on Seniors Update

[C]hanges included in the so-called “Affordable Care Act” drastically cut payments to Medicare Advantage plans starting in 2013, driving many MA plans out of business, and forcing the surviving plans to slash benefits. According to a recent study I wrote with Michael Ramlet, these cuts will cause the beneficiaries in the average county (MA plans are offered on a county-level basis) to lose two-thirds of their MA plan choices by the time the new payment formula is fully phased in in 2017….

The average beneficiary — considering both those who stay in the stripped-down MA program, and those who transition out of it — will incur an average cut of more than $3,700 in benefits per year by 2017.

The decline in both plan offerings and in enrollment will vary substantially across the country. In Texas, for example, beneficiaries will face an average loss of more than three quarters of plan offerings per county by 2017….

The percentage of beneficiaries pushed out of the program ranges from 38 percent in Montana to a 67 percent in Washington, D.C., and 84 percent in Puerto Rico. Average benefit losses range from a low of $2,780 in Montana to a high of $5,092 in Louisiana.

Full Robert Book post here. See our previous posts here and here.

 

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Nov 02, 2011 | 7 comments | by

The Texas Model for Fixing Social Security

Texas Gov. and Republican presidential hopeful Rick Perry is pointing to three Texas counties that decades ago opted out of Social Security by creating personal retirement accounts.

Those who retire under the Texas counties’ Alternate Plan do much better than those on Social Security.

  • A lower-middle income worker making about $26,000 at retirement would get about $1,007 a month under Social Security, but $1,826 under the Alternate Plan.
  • A middle-income worker making $51,200 would get about $1,540 monthly from Social Security, but $3,600 from the banking model.
  • And a high-income worker who maxed out on his Social Security contribution every year would receive about $2,500 a month from Social Security versus $5,000 to $6,000 a month from the Alternate Plan.

See Wall Street Journal editorial by Merrill Matthews

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Sep 27, 2011 | 5 comments | by

Are Seniors Getting Too Many Tests?

Every year like clockwork, Anna Peterson has a mammogram. Peterson, who will turn 80 next year, undergoes screening colonoscopies at three- or five-year intervals as recommended by her doctor, although she has never had cancerous polyps that would warrant such frequent testing. Her 83-year-old husband faithfully gets regular PSA tests to check for prostate cancer. … But increasingly, questions are being raised about the over-testing of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s. Critics say there is little evidence of benefit — and considerable risk — from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.

Sandra G. Boodman in the Washington Post.

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Sep 16, 2011 | 8 comments | by

Obama’s Threat to Withhold Social Security Checks is Completely Baseless

Early last week, President Obama stated that he could not guarantee that Social Security would be able to send out $20 billion in Social Security benefits if Congress did not come to a balanced budget resolution or raise the debt limit.

httpv://www.youtube.com/watch?v=1jv3wxWBRYU

While sending American seniors into a tizzy, Obama’s statement misrepresents the accounting practices of the Social Security Administration (SSA), as NCPA Senior Fellow Thomas Saving explained in the Wall Street Journal this morning. Although bonds in the Social Security trust fund are nothing more than IOUs that the government writes to itself, they nonetheless count toward the debt ceiling.

As a result, the Social Security checks the president threatened to not send to America’s seniors will not push spending closer to the debt limit. “Instead,” says Saving, “by redeeming bonds in the Social Security Trust Fund the federal government can borrow the funds and pay benefits without any affect at all on the debt ceiling.”

See David Friedman on this issue here.

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Jul 22, 2011 | 6 comments | by

Is a Medicare Rebate Proposal a Way of Taxing Seniors?

A proposal to add Medicaid-style rebates to the Medicare Part D program has been introduced in Congress by Representative Henry Waxman (D-CA) and Senator Jay Rockefeller (D-WV). It has also been endorsed by the White House. The proposal would require drug manufacturers to pay a Medicaid-style premium for the opportunity to sell prescription drugs to low-income seniors who qualify for Medicare and Medicaid. But that would force other seniors to pay higher premiums as a result, according to an analysis by the American Action Forum:

  • Medicare Part D rebates would increase prescription drug premiums for 17.7 million seniors by 20 to 40 percent.
  • Medicare Part D rebates would increase annual out-of-pocket spending for 17.7 million seniors by as much as $208.80 per year.
  • Medicare Part D rebates would increase the total out-of-pocket drug costs for seniors nationwide by $1.5 billion to $3.7 billion per year.
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Jul 21, 2011 | 4 comments | by

Seniors on Medicare Consume Twice as Much Care

This is from a WSJ editorial by Merrill Matthews and Mark Litow:

Almost all discussions about Medicare reform ignore one key factor: Medicare utilization is roughly 50% higher than private health-insurance utilization, even after adjusting for age and medical conditions. In other words, given two patients with similar health-care needs—one a Medicare beneficiary over age 65, the other an individual under 65 who has private health insurance—the senior will use nearly 50% more care.

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Jul 14, 2011 | 11 comments | by

Should Seniors be Rewarded for Choosing Lower-Cost Services?

Can Medicare save money by giving patients cash to make cost-saving decisions? This is the subject of an article from Reason.

The basic idea, dubbed cash-for-care, is as simple as a year-end performance bonus. When faced with two treatments of roughly equal efficacy but dramatically different cost, Medicare would pay patients a cash fee if they chose the less expensive option. The idea is a form of shared savings. But where most shared savings plans share exclusively with health care providers, Cash for Care shares it with patients.

Yet this should not be confused with consumer driven health care, where providers compete for cash-paying patients.

And that’s the biggest potential problem for a program like Cash for Care: It still relies on experts and administrators to make decisions about which treatments to encourage, and which ones to discourage, and how much to pay for each.

A better way would be for the doctors and hospitals themselves to figure out more efficient ways to provide care by getting a share of the savings. Providers should be able to negotiate with CMS to share in the savings if they can find efficiencies that are currently not being utilized.

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Jun 28, 2011 | 5 comments | by

Will the Affordable Care Act Cause Seniors to Die Early?

A recent paper by Vivian Wu and Yu-Chu Shen studied the effect of Medicare funding cuts on hospital mortality as a result of the Balanced Budget Act of 1997. They concluded that mortality rates increased at hospitals that suffered the largest Medicare funding, causing reductions in staffing and adoption of other cost-cutting measures. Wu and Shen found a 1% reduction in hospital payments increased mortality by about 0.4%.

How many seniors might die as a result of Medicare cuts required by the ACA? Calculations are back-of-the-envelope at best. About 5% of Medicare enrollees die in any given year. Multiplying the percentage reduction in projected Medicare payments and extrapolating the proportion of Medicare enrollees who die annually suggests a total of 6,300 additional deaths among the Medicare population from 2011 through 2019.

This is not farfetched — numerous studies have found Medicare regions with higher-spending have better outcomes than lower spending regions. For instance, a study [gated, but with abstract] by George Mason professor Jack Hadley and Urban Institute scholars found:

On average, greater medical spending is associated with better health status of Medicare beneficiaries, implying that across-the-board reductions in Medicare spending may result in poorer health for some beneficiaries.

Hadley and his co-authors found 10 percent greater medical spending over a three year period is associated with 1.5 percent greater odds of survival.

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Jun 06, 2011 | 5 comments | by
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