Werthless wrote:but most healthcare costs (I'm sure docsmooth has the actual numbers) are spent on end of life care. When I'm old, I'm going to try to die at home instead of in a hospital. Hey, a guy can dream!

Not most, exactly, but a startling amount of total spending goes for end of life care. Like most rhetorical category labels, "end of life care" is too loose to be of a lot of value sorting out what if anything ought to be done to amend how we "do" it. Rendering some of that kind of care makes eminent sense; some is tantamount to torture. A lot is in-between.

And you're on to something about 'dreaming' your way out; I expect in the next 20 years or so we'll reconcile ourselves to some variant of the way Edward G. Robinson exited Soylent Green, not because it's better, or more moral, but because our current conventions are grotesque.

Werthless wrote:

Monkeyboy wrote:

CalvinBall wrote:think he is hoping that is the case

Yup. 50 hours, yeh, that's how long it will take.

If it's bad when people don't sign up, then I just have to wonder why the republicans are so gleeful at the low signup numbers. It's almost like they want it to fail. They just can't have it look like government can help solve society's problems. The moment it looks that way, their whole ideology falls apart.

You=bad at reading comprehension.

You= good at missing the point.

I got that we were supposed to "imagine" it. I just don't think you picked a ridiculously high number by accident.

As for the Supremes taking up the birth control mandate: If they strike it down, does that mean people can sue if they don't like where their tax money goes? Serious question. Isn't this a bit of a Pandora's Box? If so, I'm cutting off the defense department on the grounds that killing people goes against my Christian upbringing and beliefs.

My understanding is that 80% of healthcare costs are spent during the last 20% of life.

JFLNYC wrote:My understanding is that 80% of healthcare costs are spent during the last 20% of life.

To Werthless's point I think it's something like 40 percent in last year of life. But that raises something I hadn't considered before: if they're switching aspects of reimbursement to outcomes rather than just paying for services,, how do you gauge end of life care? Or is that area exempted?

dajafi wrote:

JFLNYC wrote:My understanding is that 80% of healthcare costs are spent during the last 20% of life.

To Werthless's point I think it's something like 40 percent in last year of life. But that raises something I hadn't considered before: if they're switching aspects of reimbursement to outcomes rather than just paying for services, how do you gauge end of life care? Or is that area exempted?

The underscored is exactly the nub of this particular aspect of deranged health spending: because it's not "a" thing that defines, or quantifies, well.

My dad was getting "end of life" care during the last 4 weeks of his life this summer, only neither he nor I nor my mom nor anyone treating him really "knew" that. He was passing out randomly, falling down, smacking his skull on sinks, his bedframe, etc at different times of day, getting pretty dinged up. Other than the few seconds of passing out, his vital signs, any indicators any clinician could measure and act on, were as good as they have been the past 5 years. Everyone including him knew his heart was in bad shape, but it was going along about as it had for a long time. Why not another year, another 3 years? He was only 88, & still had all his marbles, & his great sense of humor.

He was hospitalized a couple of times in that month, but those stays were pretty routine observational affairs following an ER trip (wow, did those annoy him; he never liked being the center of attention). HIS big health care "spend" was 4 years ago, when he had a pacer installed, & which about 50% of the clinicians involved were unconvinced would do any good. The other 50% were pretty sure it might help somehow. Nobody really knows even now whether or not it did. The events surrounding that treatment comprised his big lifetime health spending year, easily 80% of every penny ever spent on "real" medical, clinical treatment in his lifetime.

Some other people wind up having round-the-clock nursing, complex surgeries, the works, for many many days at their end of life; others (many others) die peacefully in their sleep. They're young, they're old, they have every reason to live, they've been hanging by a thread. They're all at their "end of life".

So I've gotta again urge everyone to unpack heuristics like this carefully. 40% (or 80%) of what - all health spending for that individual's lifetime? Or 40% of some average person? Or something else? Health spending averages are just not very good for anything all that often, because the dispersion of individual cases around "average" is frequently really big - the average isn't representative of many actual people. Caution with respect to using averages matters, for assessing how possible alternatives to what we are already doing.

Condolences, doc. And your point is well taken.

Monkeyboy wrote:

Werthless wrote:

Monkeyboy wrote:

CalvinBall wrote:think he is hoping that is the case

Yup. 50 hours, yeh, that's how long it will take.

If it's bad when people don't sign up, then I just have to wonder why the republicans are so gleeful at the low signup numbers. It's almost like they want it to fail. They just can't have it look like government can help solve society's problems. The moment it looks that way, their whole ideology falls apart.

You=bad at reading comprehension.

You= good at missing the point.

I got that we were supposed to "imagine" it. I just don't think you picked a ridiculously high number by accident.

You misinterpreted everything. I picked 50 hours intentionally because it is easy to imagine how behavior can be affected at such levels. It's hard to talk about how behavior is affected unless we pick a number that will impact a large amount. It's like if I say "increasing the price of gas by $0.10/gal tax will decrease consumption," it might be tempting to say "no way, if you have to drive, you'll drive." But when you think about how you would be affected by a $10/gallon tax, you can easily visualize how behavior would be affected. Well, the $0.10/tax may affect people, but in very small magnitudes. Maybe 1 out of 50 people change their behavior (ie. combine errand trips to limit distance) with $0.10/gal tax, but it still has an economic effect.

But getting back to health insurance, anything that is not "seamless" will lose people on the margins. If it takes 8 hours, then you're going to get people to say "I'll deal with this later." Maybe they do, maybe they don't. If it takes 2 hours, then someone learns that their cost would go up 50%, they might say "I'll deal with that later." Again, maybe they do, maybe they don't. As you increase the cost, in time investment, you're going to get more people dropping out along the way. It's easy to imagine at 50 hours, but harder to imagine at 2 hours. My uncle is lazy, and because he doesn't have dependent, I could totally see him not getting around to signing up if it's a big hassle. I'm not calling it rational or irrational, but it's just the way it is.

Your second comment is a misinterpretation, but I'm not sure you care. So I'll let that rest.

Monkeyboy wrote:As for the Supremes taking up the birth control mandate: If they strike it down, does that mean people can sue if they don't like where their tax money goes? Serious question. Isn't this a bit of a Pandora's Box? If so, I'm cutting off the defense department on the grounds that killing people goes against my Christian upbringing and beliefs.

No. Not a lawyer, but if memory of my wife's law school classes serves me right, I believe that hippies brought a suit in this vein to defund their contributions to the Vietnam War. Obviously lost.

I havent read the birth control case, but I am fairly sure they are making a different argument than "we don't like where our tax money is going."

I'd say 10 cents a gallon tax would change my behavior, except that happened when gas when from 1.50 to 1.60 a gallon. Try to limit myself to a tank every two months, and even then I feel like it's a wasteful extravagance.

Monkeyboy wrote:As for the Supremes taking up the birth control mandate:

Did they put out a new song I don't know about?

Stop, In the Name of Love, Before I Take My Mandated Birth Control Pill

Werthless wrote:

Monkeyboy wrote:As for the Supremes taking up the birth control mandate: If they strike it down, does that mean people can sue if they don't like where their tax money goes? Serious question. Isn't this a bit of a Pandora's Box? If so, I'm cutting off the defense department on the grounds that killing people goes against my Christian upbringing and beliefs.

No. Not a lawyer, but if memory of my wife's law school classes serves me right, I believe that hippies brought a suit in this vein to defund their contributions to the Vietnam War. Obviously lost.

I havent read the birth control case, but I am fairly sure they are making a different argument than "we don't like where our tax money is going."

they do not think that their business should be required to purchase health insurance that would include coverage for birth control. if not birth control, why not heart medication? why not blood pressure meds? why should someone against blood transfusions have their business buy insurance that covers surgeries? they fundamentally misunderstand what health coverage is, and what it is not. it allows a person to be able to access such items, it does not make the business pay for those items. they are paying for the employee's right to possibly, maybe, access those items, for various reasons. you don't get to impose your morality on your employee.

Werthless wrote:

Monkeyboy wrote:As for the Supremes taking up the birth control mandate: If they strike it down, does that mean people can sue if they don't like where their tax money goes? Serious question. Isn't this a bit of a Pandora's Box? If so, I'm cutting off the defense department on the grounds that killing people goes against my Christian upbringing and beliefs.

No. Not a lawyer, but if memory of my wife's law school classes serves me right, I believe that hippies brought a suit in this vein to defund their contributions to the Vietnam War. Obviously lost.

I havent read the birth control case, but I am fairly sure they are making a different argument than "we don't like where our tax money is going."

I also haven't read much about the case, but it's not their tax money. It's them being compelled by the government to purchase a product from private companies that includes something they morally object to or else face heavy fines.

TenuredVulture wrote:I'd say 10 cents a gallon tax would change my behavior, except that happened when gas when from 1.50 to 1.60 a gallon. Try to limit myself to a tank every two months, and even then I feel like it's a wasteful extravagance.

a tank every two months, aren't you special

pacino wrote:

TenuredVulture wrote:I'd say 10 cents a gallon tax would change my behavior, except that happened when gas when from 1.50 to 1.60 a gallon. Try to limit myself to a tank every two months, and even then I feel like it's a wasteful extravagance.

a tank every two months, aren't you special

I live in a small town. Nothing is more than a couple of miles away. Except liquor, and then I use Mrs. Vulture's car. Mostly, I take my bike for my 2 mile commute.

pacino wrote:

Werthless wrote:

Monkeyboy wrote:As for the Supremes taking up the birth control mandate: If they strike it down, does that mean people can sue if they don't like where their tax money goes? Serious question. Isn't this a bit of a Pandora's Box? If so, I'm cutting off the defense department on the grounds that killing people goes against my Christian upbringing and beliefs.

No. Not a lawyer, but if memory of my wife's law school classes serves me right, I believe that hippies brought a suit in this vein to defund their contributions to the Vietnam War. Obviously lost.

I havent read the birth control case, but I am fairly sure they are making a different argument than "we don't like where our tax money is going."

they do not think that their business should be required to purchase health insurance that would include coverage for birth control. if not birth control, why not heart medication? why not blood pressure meds? why should someone against blood transfusions have their business buy insurance that covers surgeries? they fundamentally misunderstand what health coverage is, and what it is not. it allows a person to be able to access such items, it does not make the business pay for those items. they are paying for the employee's right to possibly, maybe, access those items, for various reasons. you don't get to impose your morality on your employee.

Now I'm imagining a tidal wave of businesses suddenly asserting they're Jehovah's Witnesses, and not wanting to pay for jack shit.

A corporation is now a "person" for religious beliefs, too? If they want to enjoy the limited liability bestowed upon them by the state, then they should have to play by the state's rules, including health insurance. Want to assert your individual religious beliefs? Give up the corporate shield.

jerseyhoya wrote:I also haven't read much about the case, but it's not their tax money. It's them being compelled by the government to purchase a product from private companies that includes something they morally object to or else face heavy fines.

Health insurance fucks everything up. Think of it as the employee making the 'purchase' of products that HL leadership - but maybe not 1 or more employees -regard as the implements of Satan, to satisfy health needs the employee and their physician have reached a health decision on. The employer has simply provided compensation in a particular, regulated, form - health benefits in this case. How would you feel if the employer insisted on putting the employee's paycheck on a smartcard that could only be used to buy things the employer approved of? (Geez, don't think about that too hard, there's probably some reactionary loon already working on such a thing).

The employer has purchased health insurance because a) it helps in the competition for employees (in the case of Holy Roller-er, Hobby Lobby, it makes them seem, in their employees' eyes, less like freaky religious zealots) and b) under ACA if they choose to offer health insurance they need to provide a plan or plans that provide support/risk protection for purchase of a variety of stuff - they have to meet a standard that applies to everyone in the marketplace.

I'm pretty sure this case centers on a federal statute rather than a Constitutional provision directly. That is, there's room for the court to wiggle, and old Corporation John likes to wiggle. I could see him hewing to the market-state line & deciding that in the market square, your religious preferences take a back seat to "pure" market activity. That would align with his previous action on ACA overall, and steer clear of mussing Citizens United.

JFLNYC wrote:A corporation is now a "person" for religious beliefs, too? If they want to enjoy the limited liability bestowed upon them by the state, then they should have to play by the state's rules, including health insurance. Want to assert your individual religious beliefs? Give up the corporate shield.

mark me down as for J's program. This decades-long extension of the idea of corporation as a genuinely 3-dimensional person, rather than a crudely formed, narrowly purposed, creature of the marketplace has got to be reined in. This seems like an easy place to start. Even Corporation John gets this. And if he doesn't, the sudden flame flickering under the political activities of non-profits may incite him to find a way to wall that administration pursuit off while squelching the Hobby Lobby jobby.

Werthless wrote: My uncle is lazy, and because he doesn't have dependent, I could totally see him not getting around to signing up if it's a big hassle. I'm not calling it rational or irrational, but it's just the way it is.

Was hoping you'd call on the ghost of Coase to shore up your position. We haven't considered matters of transaction costs directly anywhere around here that I can recall.