Reply #22: Cost containment models do not work when years of neglect lead to congestive heart failure [View All]

for example, a diagnosis which consumes a disproportionate percentage of Medicare's resources. "Cost containment" as the insurance plans advocate it is about helping the patient who develops CHF die more quickly so that he will use up less resources on end of life care. Prevention would keep that heart healthy---and use the dollars saved from all those healthy hearts to provide the extraordinary care that a very few people would need for trauma or rare diseases.

True story. Years ago, a patient of mine developed lung cancer on top of her COPD. Her pulmonologisat would occasionally tap her malignant effusion so she could breathe. The HMO had a doctor call me to say that they wanted her on hospice and any treatments designed to prolong her life had to stop.

It is episodes like this which sour me to insurance companies and their "cost containment." Too often what we see are insurance reps who mark some patient as easy to screw (i.e. they are not likely to sue) and they find an excuse to deny necessary care. All on the grounds of "cost containment."

An investment in universal cradle to grave insurance with an emphasis on disease prevention that includes a public health policy designed to encourage healthy life style changes is the only way to contain our runaway costs. Under private insurers and their so called managed care, medical costs per person have doubled since Bill Clinton was in office, from 3k to 7 k a year person.