Obamacare Going Down?

[econ21]

The truth is that the vast majority of healthcare spending in the US is end of life care. It is incredibly expensive to keep people alive who should be dead. The Left is afraid to admit that Sarah Palin was essentially correct. To truly bring America's healthcare costs in line with other nations in a government run system, some higher authority (i.e. death panels) will have to step in and make decisions about what is and is not appropriate end of life care. Left up to families and/or individuals, most people will opt to live as long as possible, especially if insurance is footing the bill.

I don't think that is a truth. End of life care (i.e. care in the last year of life) is maybe 27-30% of medicare spending and there is more to health care spending in the US than medicare. There's not much data on it but one study suggests spending on end of life care takes a similar proportion of total health care spending in the US and some other countries like Holland:

http://stevereads.com/papers_to_read...d_of_life_.pdf

I think your final rider about insurance may be more to the point. The US system may have less incentive to restrain costs across the board, not just at the end of life.

Interestingly studies seem to contest the commonsense view that increasing life expectancy will inevitably inflate health care costs per person per year. Controlling for time to death, extra years of age among the elderly reduce health care costs at the end of life - perhaps because they are less likely to want to be hospitalised. The share of spending on end of life care has not risen markedly over the last two decades. The point seems to be that it's not being old that raises health care costs - it's being close to death (i.e. in the last year of life).

Now, of course, Palin was trying to invoke an Orwellian emotional reaction for political gain. It would be nice, though, if politicians would acknowledge the essential fact that under a socialized system people's lives would necessarily have to be weighed against a budget instead of acting like the healthcare issue can be solved through the elimination of waste, fraud, and abuse.

There's always a budget constraint, whether the budget is private or public. The argument for the socialised system is that it will pay for those whose private budget wouldn't run to it. Those with higher incomes can always use their own private budget (including via private insurance) to get more health care if they choose. If the socialised system is decent enough, they won't. I suspect it's not just "death panels" that see the futility of extending the life of people who "ought to be dead". If the extra bit of time you could eke out is miserable, people may think it's not worth squandering what they have accumulated to pass on to the next generations.