
Medicare: Not Such a Budget-Buster Anymore - lcuff
http://www.nytimes.com/2014/08/28/upshot/medicare-not-such-a-budget-buster-anymore.html?src=me&module=Ribbon&version=origin&region=Header&action=click&contentCollection=Most%20Emailed&pgtype=article&abt=0002&abg=1
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eli_gottlieb
So the good news is that Medicare is no longer blowing up in cost, and we now
project being reasonably able to pay for it.

The bad news is, this reduction in cost seems to be happening at least
partially because people are just getting less actual care.

The unremarked but persistent fact is that if we poured the savings from
Medicare into preventative medicine - particularly into fixing problems of
diet, exercise, and aging - we would not _need_ anywhere near the same amount
of health-care spending on the elderly.

~~~
_delirium
The last point seems to depend on a lot of assumptions. Simply making someone
healthier for longer doesn't automatically save money: someone who dies of a
heart attack before age 65 is actually the _best_ financial case for Medicare,
and improving their health moderately so that they still have heart disease,
but it doesn't kill them until age 75, will cost more! Improving their health
even more than that, so that they don't have heart disease, but die of cancer
at age 85 after 9 months of chemotherapy and 3 months on life support, is more
expensive still.

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eli_gottlieb
Well, admittedly, I was kind of assuming that we're "going in" having already
ruled out saving healthcare money by _causing people to die prematurely_. But
do you happen to know of a graph or table or something on the fiscal trade-
offs between health, life-span, and spending on care, which would demonstrate
that even if someone remains in very good health until they die, simply having
them alive longer costs so much money that it would be _preferable_ to spend
less and have them die earlier?

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refurb
I'd would have loved it if the article actually went into the forecasting
method used for the Medicare budget. I'm sure it's available online, but I
don't have the time to search for it.

Medical cost inflation underwent a pretty sharp decline over the past few
years. If they are just taking a running 3-year average rate of cost increase,
then the change to projections makes sense, but really concerns me. What if
medical inflation triples next year? Then we're back in the same old boat.

