Are We Anywhere Close to Containing the Costs of Healthcare?

At the Wall Street Journal, "The Crushing Cost of Care":

On Valentine's Day 2009, Scott Crawford, 41 years old, received the break that he thought would save his life. A surgeon at Johns Hopkins Hospital in Baltimore removed his ailing heart and put in a healthy one. The transplant was a success.

But complications put the former tire-warehouse worker in intensive care for almost a year. Surgeons removed his gall bladder, his left leg and part of a lung. And Mr. Crawford soon became one of the most expensive Americans on Medicare.

A sliver of the sickest patients account for the majority of Medicare spending - and young people can often have the highest costs. WSJ's Janet Adamy discusses the case of Scott Crawford, who became one of the most expensive Americans on Medicare.

As his condition turned grave, one of his doctors questioned whether to keep treating him. Nurses reported feeling "moral distress" over his unrelenting pain. Still, medical opinion was split, and Mr. Crawford's family, with the backing of his transplant surgeon, pushed forward.

A few days before Christmas 2009, Mr. Crawford died, leaving behind a young son.

According to a Wall Street Journal analysis of Medicare data, the government spent $2.1 million on his inpatient and outpatient care in 2009. That was the fifth costliest of all Medicare beneficiaries that year and the highest among those who died by that year's end. Medicare covered Mr. Crawford's costs through federal disability insurance.

A primary goal of the 2010 health-care overhaul that the Supreme Court upheld last week is to slow the growth of costs. Even so, the law does little to address a simple fact: A sliver of the sickest patients account for the majority of U.S. health-care spending. In 2009, the top 10% of Medicare beneficiaries who received hospital care accounted for 64% of the program's hospital spending, the Journal's analysis found.

Younger patients like Mr. Crawford were more expensive, representing just 18.5% of the beneficiaries who received hospital care but 23.7% of the total cost. Seniors vastly outnumbered them, however, and consumed 76% of the total hospital costs.

As for Medicare's long-term cost trajectory, it is relentlessly upward. The program's net expenditures totaled $486 billion last year, according to the Congressional Budget Office, or 13.5% of all federal expenditures. In March, the CBO projected that Medicare expenditures would grow an average of 5.7% per year through 2022 and equal 16.2% of all federal outlays.

Medicare patients rack up disproportionate costs in the final year of life. In 2009, 6.6% of the people who received hospital care died. Those 1.6 million people accounted for 22.3% of total hospital expenditures, the Journal's analysis shows.

But efforts by policy makers to tackle the question of end-of-life care have foundered recently. In the debate over President Barack Obama's health-care overhaul, an initiative to help Medicare beneficiaries plan end-of-life care sank after opponents labeled it a "death panel."

"We're always going to have patients in the Medicare program that need a disproportionate number of resources," said Jonathan Blum, deputy administrator and director for Medicare. As for Mr. Crawford, "A lot of the costs were driven by complications that could have been avoided," he said, citing an early infection as an example.

Continue reading.

Some patients are going to cost more, despite all the treatment to prevent infections and so forth. And when you get a patient like Mr. Crawford, no one's going to recommend that we pull the plug, because that's not what we do. The problem is that overall healthcare costs are out of control and ObamaCare will not address the problem and is expected to make matters worse.