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View Diary: Is Medicare 'Grand Bargain' still on the table? (174 comments)

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  •  thank you for bringing some intelligent (1+ / 0-)
    Recommended by:
    Into The Woods

    discourse into this slamfest of obama.

    i really don't understand the self-destructive behavior of those who gang up and screech loudly about the elected official that iis NOT john mccain/sarah palin!

    you'd think they would prefer mccain to the current occupant from all the negatives posted here.

    some folks refuse to live in the real world, preferring instead, a virtual reality of a non-achievable utopia.

    MOVE'EM UP! ROLL'EM OUT... MOVE'EM UP RAWHIDE!!! meeeoooow! mrraaarrr!! meeeOOOOOW!

    by edrie on Wed May 25, 2011 at 08:26:24 PM PDT

    [ Parent ]

    •  I Have Had and Will Have My Days When (2+ / 0-)
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      samddobermann, pundit

      Obama drives me up a wall but what I've come to grips with is:

      1) Much better to have him in there than any Republican.
      2) Our best chance of persuading him is also our only chance of keeping ground we win once he's gone:  Changing the political environment in both Congress and more importantly the public square.

      No politician can give us what we want.
      Only when we demand it will they provide it.  

      At bottom, I believe that we are more important than he is.  

      In the long run, he will be gone and the next one will rise in his place.  

      As we pasted all our bad karma on Bush which allowed the GOP to dump it with him over the edge of the balloon-basket like the unwanted ballast it was, if we allow Obama to become the vessel of all our good karma, it will leave with him when he goes.

      That sounds pretty mystic, but its more grounded in hard-core grassroots democracy.  

      That's where the power is.  Folks like Obama can tap that power and I wish he'd put it to greater use and through his talents make it grow again.

      But whether he does or does not, it will still be there as it was in Tunisia and Egypt and Libya etc.

      And for those who think of all that as sap, I'll tell them that sap is what keeps the tree alive.

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Wed May 25, 2011 at 11:19:26 PM PDT

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    •  NYT - Squandering Medicare's Money (1+ / 0-)
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      Here's another oped on the same issue covered by the New Yorker article.

      Squandering Medicare’s Money
      Published: May 25, 2011

      Medicare pays for routine screening colonoscopies in patients over 75  in patients over 75 even though the United States Preventive Services Task Force, an independent panel of experts financed by the Department of Health and Human Services, advises against them (and against any colonoscopies for patients over 85), because it takes at least eight years to realize any benefits from the procedure. Moreover, colonoscopies carry risks of serious complications (like perforations) and often lead to further unnecessary procedures (like biopsies). In 2009, Medicare paid doctors more than $100 million for nearly 550,000 screening colonoscopies; around 40 percent were for patients over 75.

      • The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than $50 million in 2008 on such screenings, as well as additional money on unnecessary procedures that often follow.

      • Two recent randomized trials found that patients receiving two popular procedures for vertebral fractures, kyphoplasty and vertebroplasty, experienced no more relief than those receiving a sham procedure. Besides being ineffective, these procedures carry considerable risks. Nevertheless, Medicare pays for 100,000 of these procedures a year, at a cost of around $1 billion.

      • Multiple clinical trials have shown that cardiac stents are no more effective than drugs or lifestyle changes in preventing heart attacks or death. Although some studies have shown that stents provide short-term relief of chest pain, up to 30 percent of patients receiving stents have no chest pain to begin with, and thus derive no more benefit from this invasive procedure than from equally effective and far less expensive medicines. Risks associated with stent implantation, meanwhile, include exposure to radiation and to dyes that can damage the kidneys, and in rare cases, death from the stent itself. Yet one study estimated that Medicare spends $1.6 billion on drug-coated stents (the most common type of cardiac stents) annually.

      • A recent study found that one-fifth of all implantable cardiac defibrillators were placed in patients who, according to clinical guidelines, will not benefit from them. But Medicare pays for them anyway, at a cost of $50,000 to $100,000 per device implantation.

      The full extent of Medicare payments for procedures with no known benefit needs to be quantified. But the estimates are substantial. The chief actuary for Medicare estimates that 15 percent to 30 percent of health care expenditures are wasteful. Medicare spending exceeded $500 billion in 2010, suggesting that $75 billion to $150 billion could be cut without reducing needed services.

      And before the GOP goes all 'death-pannels' on us, they should remember that the concept behind "Medicare Advantage" and it's use of the HMO's was that HMO's have been doing this kind of productivity enhancement for decades.  

      In a different form, so have places like Mayo Clinic (as discussed in the New Yorker article.)

      Not even touched on in either of these articles are the end of life treatments that are epitomized most starkly by what the medical professionals refer to as "resuscitating someone to death", when a frail and elderly patient who may desire no extraordinary measures is subjected to what amounts to frantic and brutal physical contact that is ineffective in almost all cases once the patient is in a fairly identifiable set of conditions.  

      The choice should always be there, but the discussions of the facts that should be known before anyone consents in advance to such treatments are not going on as much as they should, resulting in both over-treatment and unnecessary anguish to patients, families, and medical providers.

      The unproductive and in many cases counter-productive treatments that are provided (and consented to) in the last few months of life are causing worlds of pain, reduced quality of life without compensating quantity of life, and last and surely least, costing wasteful amounts of money.

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Thu May 26, 2011 at 12:02:00 AM PDT

      [ Parent ]

      •  ITW, which NYorker article (1+ / 0-)
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        Into The Woods

        are you referring to?

        The June 1st on by Atul Gawande or one of his other ones?

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... I'm asking you to believe in yours. Barack Obama

        by samddobermann on Thu May 26, 2011 at 04:09:09 AM PDT

        [ Parent ]

        •  Atul Gawande's article. (0+ / 0-)

          I know that in some ways it is out of date, as the comparisons of Medicare costs per recipient now include not only the raw costs per recipient but also adjustments for local labor costs and other factors, but while the disparities may have been reduced, there are still major disparities, unexplainable by patient population.  

          I've not yet dug into whether the "sickness" level of patients that is part of those adjustments is something that could be skewed by the very churning that may be part of the problem.

          Here's the comparison of Medicare Costs by metro area (both raw and adjusted.)

          We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

          by Into The Woods on Thu May 26, 2011 at 11:19:54 AM PDT

          [ Parent ]

      •  fyi, (1+ / 0-)
        Recommended by:
        Into The Woods

        when my mother was rushed to the er in a sudden onset coma from the rehab facility - she was in (undiagnosed) advanced stage lung cancer.  my sister was with her.

        the young doctor, after the diagnosis was made, wanted to go extraordinary lengths - putting in breathing tube, oxygen, etc., to get air into her lungs to help her survive the night.  when asked what would happen if she DID make it through the night, then what - she had a dnr request and did not want to have her body simply "kept alive", then what were the procedures for removing the life support machines.

        his response was "well, YOU are certainly being 'intellectual!', aren't you!" my sister then told him she had mother's power of attorney.  he left the room and never returned.

        the older doctor came in and said that it was almost certain she wouldn't survive the night and offered to call in hospice.

        my mother at the last moments of her life, opened her eyes, smiles broadly and reached upward - and then was gone.

        that transition would never occurred had the young doctor prevailed - the one who saw the "patient" that could be "prolonged" ad infinitum - without any hope of cure.  


        medicare pays for long term treatment.

        yes, there is room for improvement when we finally become honest about the contract that each of us enters when we are born:  we die.  NO person has ever escaped that contract - not a single one.

        to deny that death is a part of life is to see it as something horrible, awful, unnatural.

        medicare and medicine is finally making progress with hospice.  by providing families with honest end of life choiices, we are all more human.  we are all better for it.

        for some reason, many are too afraid to "go there"... but, eventually they and we all will.  it is how that matters.

        peace to all and may your transition, when that time comes, be as beautiful as my mother's.

        MOVE'EM UP! ROLL'EM OUT... MOVE'EM UP RAWHIDE!!! meeeoooow! mrraaarrr!! meeeOOOOOW!

        by edrie on Fri May 27, 2011 at 12:41:41 AM PDT

        [ Parent ]

        •  Thanks for sharing that. It is exactly what (1+ / 0-)
          Recommended by:

          I was talking about.

          And to give the younger doctor the benefit of the doubt, the culture and training is so weighted in the other direction, towards a mechanistic approach that slights the human, emotional side and views every occasion as a "life and death struggle".

          Sometimes it is and should be fought with every means at our disposal.

          But sometimes it is just the end of a journey.

          And at least in some of our beliefs, the beginning of another.  

          And in those cases, wrestling the person down and forcing them to endure all kinds of painful, uncomfortable, debilitating, distracting, unwanted and often unproductive measures is not appropriate.

          Sometimes, our time is better spent getting ready for the next journey and saying goodbye.  

          Glad your Mom got to do the latter.  Glad your family had discussed it and had the authority to make sure her wishes were respected.  So many don't.

          And the "death pannel" grannyscare tactics will mean more people will not have their true wishes respected at the end of their lives.

          Palin and the Republicans who joined that "death pannel" slander  have condemned more seniors to that unwanted conflict at the end of their lives and  condemned more families to not being able to stop it.

          We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

          by Into The Woods on Fri May 27, 2011 at 11:17:31 AM PDT

          [ Parent ]

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