Quote:I have heard it quoted many times that something like 2/3rds of the cost of our care is in the last year of life. You wouldn't get most of that care in other countries.

Japan has an older population, and their elderly has more care than in the U.S. Of course their doctors are paid much less than ours. However, I agree with your premise generally, that we spend an inordinate amount of money on the last year or month of life. That was what I was addressing much earlier when I talked about end-of-life care. You are preaching to the choir.
  :yes: 


 

Its not an American trait to tell people to just go off to the wood shed and die. 

Actually, it very much IS an American trait to do just that. That is what we do every year by not having health care systems in place that are similar to the other countries. I posted much earlier about the deaths due to lack of access that other countries simply do not have, yet have heard crickets in response.


 

So until just letting folks die becomes culturally acceptable, you won't won't just cut our costs.

Your premise is that in the U.S. it is not culturally acceptable for letting (old) folks die, but in other countries it is. So far the only evidence I have seen of this is your one anecdote from Canada. Out of curiosity, what was the procedure? On a more general level, what is the care that would be provided in the U.S. but not say, in any of the other Bismarck countries? I understand that a Beveridge system might ration care in the manner you describe. 


 

Combined with our leading role in medical research and development you get the highest cost system in the world.

No problem with medical R&D, but we are talking about everyday care.  I have yet to find a site that compares our costs, procedure by procedure, that does not have us listed in the top 3 for costs, and most often the most expensive. Same for drug costs. My premise stated earlier was pretty simple. We do not have price transparency, and when we do get information into pricing, we are more expensive than other countries. This has nothing to do with the graying of America, or with unneeded hip replacements(though i do not deny the validity of those points). I saw a commentator last week make the observation that folks would consider it crazy to go into a supermarket and pay ten times more for a carrot than the next person in line. Do you believe we can get health care costs in line without price transparency? 


 

I had asked earlier for feedback on how we ranked compared to other countries, and appreciate your views. I also had mentioned goals, such as universal coverage, or getting our health care costs in line with the the next 15 most expensive countries in the world. What would your goals for our system be and how would you get there?