Friday, August 28, 2009

Ted Kennedy, Cancer and are there any limits?

I have seen several places where folks ask would Ted Kennedy have gotten the same care had he had a 'public option'? I think the answer is most likely yes.

He was a federal employee. He had the federal employees health plan, which provides a series of insurance choices to employees. When you read about various reform plans setting up health insurance exchanges and the like in states whereby people can purchase plans, they are mostly based on the idea of the federal employees health plan (again, lots of options, individuals choosing what they want, and having different premiums, deductibles and the like based on their choice). The federal gov't paid premiums on behalf of Sen. Kennedy and he paid premiums as well. I don't know which plan he chose.

Since he was over 65, Medicare was a secondary payer of all of his care. If he retired, then Medicare would become the primary payer of his health insurance, and he could elect retiree Medigap insurance from the federal gov't. Medicare is a huge, federal insurance program that is primarily tax financed and covers about 45 Million Americans. It provides the best evidence of what a public option might cover, how it would work. And the answer is it covers just about anything that is not experimental. So, the short answer to the question, 'would Ted Kennedy have gotten the same care if he had a public option?' is most likely yes. I say most likely because I don't know exactly what he got. If he got something that was experimental, neither Medicare nor any private insurance company would have likely paid for it. Such care is typically received via a research study or must be paid for out of pocket.

You have a far greater chance of being denied care by a private insurance company than you do by Medicare. That is part of why Medicare is going broke and insurance companies are very profitable!

Here is a straightforward discussion of Sen. Kennedy's care, and the reality of certain types of cancer diagnoses, about 40 years after President Nixon declared the War on Cancer. There are discussions of costs, benefits, perspectives of fighting, American culture and the like. Here is an interesting discussion of progress against cancer. Most interestingly, is the distinction between increased survival after detection of cancer (that has occurred) and the relatively limited success in curing cancer, and causing/allowing someone to die of something else. Meaning for many cancer diagnoses but not all, treatments forestall death for different periods of time and improve quality of life as well. But, the notion of 'War on Cancer' implies defeat of an enemy, and that is not very likely. It doesn't mean increased research and treatment hasn't been worth it, just that the metaphor doesn't match the reality of cancer. And of course if cancer were eradicated, there would be an explosion in heart disease mortality, because the mortality rate of being born, is of course, 100%.

The health reform discussion has been mostly heat and no light on these basic questions:

(1) Are there limits to what should be done in terms of medicine/health care?
(2) Do we actually now provide treatments for which the costs are greater than the benefits?
(3) How much are benefits any incremental benefit worth any cost?
(4) If yes is the answer to question 3, how will we pay for it? What else will we forego?**
(5) If no is the answer to question 3, how do we practically work out the principle that there are limits....the principle has to be operationalized to actual care provision?
(6) How do we address all of these questions (there are many related questions and controvseries) in an American way, meaning in a way that works for our culture?

We really need some grown up discussion.

**The federal budget in 2009: Social Security (22%); Military (20%); Medicare 14%; Interest on the debt (8%); Medicaid (7%). Everything else 29%.

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