How do we wake up the sleeping “beast” that is the vast majority of Americans who won’t do preventively for themselves what no advertisement campaign in the world will “fix?” Sure, we can see some progress over the years, most notably, the decrease in tobacco dependency. Maybe we’re even exercising more. But the increase in childhood obesity and diabetes alone should scare the hell out of all of us. There are no quick fixes for those conditions. To me, they’re the “canaries” in the dark cave of health care. Kids depend on us for education, and they obviously aren’t getting it. And we aren’t giving it.

The cynical side of me says a lot of corporations stand to benefit from keeping the masses in the dark about their bodies and good health. Does anyone LIKE the proliferation of drug commercials on TV? And what do so many of them suggest: “talk to your doctor about Drug X.” We’re going to experience a great deal of pain and financial drain before the cart gets put in back of the horse where it should be. I’d like to hear just one Presidential candidate suggest this approach instead of all the other crap I’ve heard so far. Anyone else with me on this?

Such figures would involve knowing if medicine actually works. It may be possible to figure out how much money is spent on 30 year-olds with cancer and break it into the groups who survived & those who didn’t, but I doubt that the cancer medicine saved anyone.

As for arguing about something that’s probably true: (1) what I’m “arguing” about is whether BillK’s figures were just made up or not, which seems to me to be of some interest whether or not they’re roughly right, (2) I gave some reasons for being suspicious about any argument founded merely on the fraction of expenditure in the last year / N years of life, (3) even when there’s general agreement that something is probably true there’s scope for discussion about how probably it’s true and how strongly it should be stated for best accuracy, and (4) sometimes something can be very widely believed but still false.

In this instance, it seems that there’s plenty of folklore to the effect that US healthcare costs for people close to death are very high, and that this indicates that a lot of resources are going into extending lives that aren’t going to last long (or: whose quality isn’t very high regardless) anyway. But it’s still not very clear whether there’s much more than folklore. The fact that the authors of that RAND report from 2003 chose to draw that astonishingly unquantitative Figure 1 suggests to me that there aren’t any good figures to be had. (Or that there are, but that they don’t look as convincing as the impressionistic Figure 1.) I hope I’m wrong, since these seem like vital facts that need to be taken into account in framing healthcare policy.

What about you, g?

For the benefit of anyone who hasn’t taken a moment to look at figure 1 of that white paper, I’ll mention that its x-axis has exactly three labels (“Birth”, “Life span”, “Death”), its y-axis exactly one (“Expenditure”), and that it seems obvious that the curve it shows was drawn freehand and not directly derived from any actual data.

He says that there is no point in referencing studies and reports as they all have different numbers and you can get support for almost any figure you fancy.

He says that his 70%/5 years and 35%/1year spending estimate is a very conservative consensus view. In some cases over 90% is spent in the last year of life.

So I would stick with the 2003 RAND report
http://www.medicaring.org/whitepaper/index.html

That says
The overwhelming preponderance of U.S. health care costs now arise in the final years of life. Indeed, if one were to estimate costs across a life span, the shape of the expenditures reflects the new health and demographic circumstances. Figure 1 presents a rough estimate of health care costs distributed across the average American’s lifetime.

The graph shown in Fig.1 on page 1 of this whitepaper certainly agrees.

BillK

I’m sure you’re right that (1) a lot of US medical spending is on people near the ends of their lives, (2) quite a lot of it is on people *very* near the ends of their lives, and (3) it might be effective, in terms of getting more QALYs-per-buck, to reduce that. But (and I’m sorry to be repeating myself here) you quoted a couple of quite specific figures, and there doesn’t yet seem to be any evidence that you weren’t just making those figures up. And I don’t think you should do that.

One other thing. Suppose you get cancer at 30 and die three years later. Then any medical treatment you got during that time will have been “in the last 5 years of life”. It seems to me that this discussion has been framed so as to make end-of-life treatment sound as if it’s all aimed at enabling people to live to 93 instead of 92. Unless we know what fraction of this end-of-life treatment was actually aimed at enabling people to live past 33 instead of dying then but happened not to succeed, I think a discussion on those terms is inviting all sorts of broken intuitions.

Anyone got any figures for what fraction of medical expenditure is on treatment of people *who would have been within N years of death even without the particular problem the expenditure was trying to deal with*?

http://www.cdc.gov/nccdphp/burdenbook2004/toc.htm

The Burden of Chronic Diseases and Their Risk Factors:
National and State Perspectives 2004

Preface:
Chronic diseases such as heart disease, cancer, and diabetes are leading causes of disability and death in the United States. Every year, chronic diseases claim the lives of more than 1.7 million Americans. These diseases are responsible for 7 of every 10 deaths in the United States. Chronic diseases cause major limitations in daily living for more than 1 of every 10 Americans, or 25 million people. These diseases account for more than 70% of the $1 trillion spent on health care each year in the United States.