Growing Seniors Population Spell Trouble

[Renegade]

There is a demographic shift which has long been predictable, however it is clear that government policies are ill-prepared to deal with this shift.

With tens of thousands of baby boomers set to retire, the federal government is looking at a grim financial future of dwindling tax revenues and soaring social costs that will spell budget trouble for decades, Parliamentary Budget Officer Kevin Page said.

"We do not have a fiscal structure in place that will deal with aging demographics. We're going to have to make some choices," he told reporters Thursday.

Canada's falling birth rate coupled with baby boomers approaching retirement will "fundamentally" change the labour market for decades to come. In the next 10 years alone, the number of people who are retired compared to those still in the workforce will grow by 7 per cent – as much as it grew in the last four decades.

Retired workers pay less tax and draw more on programs like health care and seniors' benefits, driving up government costs.

Page said "permanent fiscal actions – either through increased taxes or reduced program spending, or some combination of both" will be needed to avoid ever-increasing government deficits.

Aging workforce to drive up debt: Report

Here is a link to the actual report: Fiscal Sustainability Report

What should the government do? My suggestions:

• 
  Increase the retirement age.
  Eliminate Old Age Security (OAS) and related benefits – the Guaranteed Income Supplement (GIS) and Spousal Allowance (SA); These programs are simply welfare systems and benefits should be folded into the existing welfare system.
  Cap healthare benefits,eliminate some coverage, and require payments of deductables.
  Require payment of healthcare premiums, proportonate to risk. (eg the older you get, the more you pay)
  Increase the contribution amounts required for public and private pensions.

Edited February 22, 2010 by Renegade

[William Ashley]

There is a demographic shift which has long been predictable, however it is clear that government policies are ill-prepared to deal with this shift.

Aging workforce to drive up debt: Report

Here is a link to the actual report: Fiscal Sustainability Report

What should the government do? My suggestions:

• 
  Increase the retirement age.
  Eliminate Old Age Security (OAS) and related benefits – the Guaranteed Income Supplement (GIS) and Spousal Allowance (SA); These programs are simply welfare systems and benefits should be folded into the existing welfare system.
  Cap healthare benefits,eliminate some coverage, and require payments of deductables.
  Require payment of healthcare premiums, proportonate to risk. (eg the older you get, the more you pay)
  Increase the contribution amounts required for public and private pensions.

1. Pay what they said they would.

2. Not spend the money they collect to pay.

1+2 = responsible government.

The real solution "realelösung" is not one that we ought to speak of in the shrinking ear shot of our seniors.

btw this is a dramatic repost -

The only working answer is to pay the debt off, and restructure health care, and reinvest payouts into government coffers to retake payouts eg. affordable government run housing. government crown corps for prescriptions, etc.. of course this money gets filtered back in, a portion of the markup on keeping them alive can be filtered back into the system.

Oddly though at times seniors tax rates actually increase in retirement.

Edited February 22, 2010 by William Ashley

[Wilber]

Increase the retirement age.

It is probably inevitable.

Eliminate Old Age Security (OAS) and related benefits – the Guaranteed Income Supplement (GIS) and Spousal Allowance (SA); These programs are simply welfare systems and benefits should be folded into the existing welfare system.

These are already income related although further changes might be warranted. Also, welfare is a provincial jurisdiction. Canceling federal programs would just transfer more load to the provinces.

Cap healthare benefits,eliminate some coverage, and require payments of deductibles.

Define capping benefits. Coverage is determined by the provinces who pay the bulk of healthcare costs and is not uniform throughout the country. I don't have a big problem with nominal deductibles as long as no one is denied care because they really can't afford them.

Require payment of healthcare premiums, proportonate to risk. (eg the older you get, the more you pay)

How do you determine risk? I'm pushing my mid sixties, walk my dog 6km on hilly terrain every morning before breakfast, do lots of yard work, eat very little processed food and won't touch any that contains more than 6% sodium. Why should I pay more than some thirty year old couch potato who exists primarily on processed food, soft drinks and beer? What about people with chronic ailments which are no fault of their own. In this respect you are describing more of a private system than a universal public system.

You need to also consider that most of those older folks who now require more care, paid into it for decades without taking anything out.

Increase the contribution amounts required for public and private pensions.

A good idea. Pension reform is one of the governments priorities as we speak.

[Renegade]

These are already income related although further changes might be warranted. Also, welfare is a provincial jurisdiction. Canceling federal programs would just transfer more load to the provinces.

Yes they are income related but not at the same income levels as wefare. If a society determines a minimium level which is required for survival, (ie the level provided by welfare benefits), why should there be a different level provided based upon age. I do not distinguish between provincial or federal programs as demographic shifts will inevitably impact the budgets of both. If more load is transfered to the province, they have the same choice as a federal govenment: raise taxes or incur debt. The net result is the same on the taxpayer regardless of which government does it.

Define capping benefits. Coverage is determined by the provinces who pay the bulk of healthcare costs and is not uniform throughout the country. I don't have a big problem with nominal deductibles as long as no one is denied care because they really can't afford them.

Capping benefits, means either putting a limit on the dollar amount of the expenditure, or alternatively restricting or eliminating access to certain types of treatments. Deductables will certainly discourage some people from seeking treatment who will claim that they cannot afford it, but ultimately it is likely one of the most important expenditures. If a person has any discretionary funds, then that amount is availalbe to pay deductables.

How do you determine risk? I'm pushing my mid sixties, walk my dog 6km on hilly terrain every morning before breakfast, do lots of yard work, eat very little processed food and won't touch any that contains more than 6% sodium. Why should I pay more than some thirty year old couch potato who exists primarily on processed food, soft drinks and beer? What about people with chronic ailments which are no fault of their own. In this respect you are describing more of a private system than a universal public system.

You determine risk the same way risk is determined in any insurance system. You isolate significant risk factors and you categorize people on how they match those risk factors. Personally I don't distinguish risk due to "fault" or not, meaning someone who is at higher risk, pays more regardless if he has made specfic choices which has resulted in that risk. Whether this is private or public, depends upon your definition. I define a system which the government is the sole administrator, a public one. I am simply proposing how it can manage such a system.

You need to also consider that most of those older folks who now require more care, paid into it for decades without taking anything out.

I can't see that a a valid argument. The nature of insurance programs (which in essence healthcare is), is that you may never claim but still pay a premium. Further, those older folks had access to care, all those years. What they paid for and recieved was access to care, regardless of whether or not they actually consumed the care. You don't get to bank your previously paid premium payments. With logic of this type you can also conclude that seniors owe more on government debt as they were around for decades when govenments incurred that debt.

A good idea. Pension reform is one of the governments priorities as we speak.

Personally I find it abhorent that the goverenment should have to force people to save for their own retirement, but as long as do-gooders are going to force the responsible to shoulder the cost of the irresponsible, I'd rather force the irresponsible to shoulder the cost of paying for themselves.

Edited February 22, 2010 by Renegade

[Renegade]

1. Pay what they said they would.

Not sure I understand. What a government promises to pay for is not an indefinite contract. As much as I don't like it, they can change policies at any time.

2. Not spend the money they collect to pay.

Again, I'm confused as to what you mean.

The real solution "realelösung" is not one that we ought to speak of in the shrinking ear shot of our seniors.

Not at all. The seniors should hear and be aware of the impact that they cause.

The only working answer is to pay the debt off, and restructure health care, and reinvest payouts into government coffers to retake payouts eg. affordable government run housing. government crown corps for prescriptions, etc.. of course this money gets filtered back in, a portion of the markup on keeping them alive can be filtered back into the system.

Based upon what, do you conclude is that this is the "only working answer"

Oddly though at times seniors tax rates actually increase in retirement.

Not really. It is only if you consider clawback of benefits which only seniors are entitled to, as a tax rate increase. If you remove the benefits to begin with, you will not have a situation where "tax rates actually increase in retirement"

[Wilber]

Yes they are income related but not at the same income levels as wefare. If a society determines a minimium level which is required for survival, (ie the level provided by welfare benefits), why should there be a different level provided based upon age. I do not distinguish between provincial or federal programs as demographic shifts will inevitably impact the budgets of both. If more load is transfered to the province, they have the same choice as a federal govenment: raise taxes or incur debt. The net result is the same on the taxpayer regardless of which government does it.

And yet you look no farther than federal programs. The net result would not be the same on the taxpayer, it would vary from province to province. A big reason we have a confederation is to share the load.

Capping benefits, means either putting a limit on the dollar amount of the expenditure, or alternatively restricting or eliminating access to certain types of treatments. Deductables will certainly discourage some people from seeking treatment who will claim that they cannot afford it, but ultimately it is likely one of the most important expenditures. If a person has any discretionary funds, then that amount is availalbe to pay deductables.

Our system already does that in many ways. Again I don't have a problem with the idea of deductibles but a basic tenant of our system is universal coverage.

You determine risk the same way risk is determined in any insurance system. You isolate significant risk factors and you categorize people on how they match tose risk system. Personally I don't distinguish risk due to "fault" or not, meaning someone who is at higher risk, pays more regardless if he has made specfic choices which has resulted in that risk. Whether this is private or public, depends upon your definition. I define a system which the government is the sole administrator, a public one. I am simply proposing how it can manage such a system.

You haven't explained how you will do it. Any other insurance system can refuse coverage to individuals it determines to be high risk. Do we deny healthcare to those who need it most?

I can't see that a a valid argument. The nature of insurance programs (which in essence healthcare is), is that you may never claim but still pay a premium. You don't bank your previous premium payments. With logic of this type you can also conclude that seniors owe more on government debt as they were around for decades when govenments overspent.

Where did you get the idea that the present Canadian healthcare system is an insurance program? It has never been. It's what we had before we brought in universal healthcare. It's the reason we decided on a government run universal system in the first place. We decided it was too important to be treated as just another insurance program.

If they are high risk, why not deny them coverage altogether. Problem solved. The government will be rolling in money, just like a well run private insurance company.

Personally I find it abhorent that the goverenment should have to force people to save for their own retirement, but as long as do-gooders are going to force the responsible to shoulder the cost of the irresponsible, I'd rather force the irresponsible to shoulder the cost of paying for themselves.

It also results in decreased revenue for government as pension contributions are not taxable and are likely to be taxed at a lower rate when withdrawn in most cases. This is one reason many private plans are in trouble right now. The government would not allow enough overfunding of plans in good times for them to remain fully funded in bad times when companies are unable to make up the deficite.

[ToadBrother]

Capping benefits, means either putting a limit on the dollar amount of the expenditure, or alternatively restricting or eliminating access to certain types of treatments. Deductables will certainly discourage some people from seeking treatment who will claim that they cannot afford it, but ultimately it is likely one of the most important expenditures. If a person has any discretionary funds, then that amount is availalbe to pay deductables.

"I'm sorry, you're 73. Our actuary tables show that you'd probably be dead within five to ten years anyways, so you don't get no chemotherapy."

[Topaz]

I could believe what you wrote. There are people out there that need these programs and if in retirement you don't need them, then you don't get them. I would say the top middle income earners and the top earners can live easily without those government programs but don't punish the people who NEED these programs in their retirement to survive!! Besides, the next generation is doing a better job with their retirement money than their parents, so it was said on a financial program.

[Renegade]

And yet you look no farther than federal programs. The net result would not be the same on the taxpayer, it would vary from province to province. A big reason we have a confederation is to share the load.

Who says I look no farther than federal programs? Some of the suggestions are made are for changes to provincial programs. Sure the impact varies from province to province. I'm fine with it, just as there are variations between healthcare programs from province to province. The problem of demongraphics is common to all provinces and the impact will be felt by all provinces. It is not like all the seniors only live in one province and the other provinces then have to carry the load.

Our system already does that in many ways. Again I don't have a problem with the idea of deductibles but a basic tenant of our system is universal coverage.

Even basic tenants are subject to change.

You haven't explained how you will do it. Any other insurance system can refuse coverage to individuals it determines to be high risk. Do we deny healthcare to those who need it most?

There is no need to deny coverage to high risk, it simply needs to be priced according. If a person is of such high risk that they cannot pay the corresponding premium, one way to handle it is to put a cap on premiums (either as a percentage of income or at a dollar amount). For those high risk individuals who cannot pay their premium, coverage can be limited to more basic care.

Where did you get the idea that the present Canadian healthcare system is an insurance program? It has never been. It's what we had before we brought in universal healthcare. It's the reason we decided on a government run universal system in the first place. We decided it was too important to be treated as just another insurance program.

Healthcare coverage is an insurance program because it has many of the characteristics of a insurance program. The definition of Insurance is Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed and known small loss to prevent a large, possibly devastating loss.. In the Canadian system the risk is borne by the government, premiums are paid by the taxpayer, and Canadian residents are the benificiaries, nonetheless, it is an insurance system.

If they are high risk, why not deny them coverage altogether. Problem solved. The government will be rolling in money, just like a well run private insurance company.

Very few individuals are high enough risk that you cannot cover them. At some point if you have too many people who are high enough risk, then yes you indeed may need to deny coverage.

It also results in decreased revenue for government as pension contributions are not taxable and are likely to be taxed at a lower rate when withdrawn in most cases. This is one reason many private plans are in trouble right now. The government would not allow enough overfunding of plans in good times for them to remain fully funded in bad times when companies are unable to make up the deficite.

Of course it would lower immediate revenues. The situation is not yet dire. It will be dire in the future. By forgoing some revenue now the government would hope to prevent an even worse situation in the future.

[Renegade]

"I'm sorry, you're 73. Our actuary tables show that you'd probably be dead within five to ten years anyways, so you don't get no chemotherapy."

Right. This is no different conceptually than what happens today. Would you deny a 97 year-old man a multi-million dollar operation which could potentially prolong his life a few months? If so, why?

Edited February 22, 2010 by Renegade

[Smallc]

Right. This is no different conceptually than what happens today.

Actually is is. My 86 year old grandmother had colon cancer removed a few years ago. She also gets thousands of dollars of drugs paid for every year just so she can keep some of her sight.

[Renegade]

I could believe what you wrote. There are people out there that need these programs and if in retirement you don't need them, then you don't get them. I would say the top middle income earners and the top earners can live easily without those government programs but don't punish the people who NEED these programs in their retirement to survive!! Besides, the next generation is doing a better job with their retirement money than their parents, so it was said on a financial program.

You seem to believe that the only criteria for a program is need. What happens once the need exceeds the capacity of the providers to pay? What then? A healthcare system which provides unlimited healthcare based soley upon what a population "needs" without any regard to what the capacity of the system to pay for those needs is a system bound for disaster. That is exactly where our system is headed.

[ToadBrother]

Right. This is no different conceptually than what happens today. Would you deny a 97 year-old man a multi-million dollar operation which could potentially prolong his life a few months? If so, why?

You're asking a loaded question. No one would debate that a 97 year old man is too old to receive anything but palliative care if he should fall ill.

Let's deal with, say, a 67 year old man, a situation which is much more likely to arise given the current demographics. Let's say he has, say, liver cancer. Under your system, would he be eligible for chemotherapy? Would he be eligible for a transplant?

What I'm looking for here is this line that is going to have to be drawn. At the moment, for the most part, it's left up to the doctor and the patient, but clearly, under your system, there is going to have to be much stricter guidelines, so tell me what they are.

Other cases abound. Will hemophiliacs have to pay for their own blood transfusions? Will people with certain genetic diseases be basically tossed out the door, seeing as medical treatment can at best prolong life for a few years? What about diseases like Parkinsons or ALS?

[Renegade]

You're asking a loaded question. No one would debate that a 97 year old man is too old to receive anything but palliative care if he should fall ill.

Let's deal with, say, a 67 year old man, a situation which is much more likely to arise given the current demographics. Let's say he has, say, liver cancer. Under your system, would he be eligible for chemotherapy? Would he be eligible for a transplant?

What I'm looking for here is this line that is going to have to be drawn. At the moment, for the most part, it's left up to the doctor and the patient, but clearly, under your system, there is going to have to be much stricter guidelines, so tell me what they are.

So then all debating is where to draw the line, not that a line must be drawn. I question whether today it is really simply up to the doctor and patient. If I'm the 97 year old patient and I want to live a few more months, is that my decision alone? If it is up to me and the doctor, and I want the procedure done despite the cost, can by doctor deny me coverage?

To answer your quetion, I'm not sure where the line is, but it is clear for me, that lines shoudl be drawn which are simply the rules of the system. A system which leaves coverage decisions to indivuals who have not finanical stake in the outcome, simply is a receipe for finanical disaster. This dilemma will only get worse as more and more expensive procedures become available due to the advancement of medical technology.

Let's say it becomes possible for indivuals to live to 200 years due to medical technology advances, however at a tremendous finanical cost, do you ignore the cost in providing the service?

Other cases abound. Will hemophiliacs have to pay for their own blood transfusions? Will people with certain genetic diseases be basically tossed out the door, seeing as medical treatment can at best prolong life for a few years? What about diseases like Parkinsons or ALS?

Yes indeed, I can see that it is possible that some of these will indeed be denied coverage. Again it would require exaustive analysis to determine where the line is and what is affordable and what is not.

-----------------------

The real problem is that a sustainable system requires hard choices. People are so horrified that they need to make the choices that they refuse to make any choices. The ultimate consequence is that the system will collapse and they will no longer need to make choices because they will have none.

Edited February 22, 2010 by Renegade

[ToadBrother]

So then all debating is where to draw the line, not that a line must be drawn. I question whether today it is really simply up to the doctor and patient. If I'm the 97 year old patient and I want to live a few more months, is that my decision alone? If it is up to me and the doctor, and I want the procedure done despite the cost, can by doctor deny me coverage?

I can almost guarantee you that any ailing 97 year old is not going to receive under any system any more than palliative care. Your argument is a classic example of a fallacious argument from a false continuum.

To answer your quetion, I'm not sure where the line is, but it is clear for me, that lines shoudl be drawn which are simply the rules of the system. A system which leaves coverage decisions to indivuals who have not finanical stake in the outcome, simply is a receipe for finanical disaster. This dilemma will only get worse as more and more expensive procedures become available due to the advancement of medical technology.

And I'd argue that many procedures are only expensive because of a relative scarcity of doctors willing to do them. The best way to bring down costs is to increase the number of such procedures. Open heart surgeries, for instance, were spectacularly expensive fifty years ago because the ability to find a surgeon was so difficult, and the general requirements were so great that only larger or well-endowed hospitals could hope to have the resources to assemble cardiac teams. By your system, we would in fact be in a situation where such surgeries would still be extremely rare, simply because we draw the line based on the cost of a procedure now, thus all but wiping out any ability to cheapen the procedure. Since the system no longer has any built-in financial or medical need to innovate, we'd stop dead in our tracks.

"Oh no, Mr. Jones, that procedure is far too new and far too expensive. If you can't pay for it, here's some numbers of some nice funeral homes."

Let's say it becomes possible for indivuals to live to 200 years due to medical technology advances, however at a tremendous finanical cost, do you ignore the cost in providing the service?

Again, you're asking fallacious and leading questions here. Obviously no medical system, even a private insurer one, is going to make such a procedure generally available. How about something more moderate, like, say, a procedure that reduces child mortality rates? You know, like vaccinations. It's not as if medical systems in the industrialized world haven't had to deal with newer procedures that cost considerable amounts of money up front.

Yes indeed, I can see that it is possible that some of these will indeed be denied coverage. Again it would require exaustive analysis to determine where the line is and what is affordable and what is not.

So the only measure of medicine is financial cost?

-----------------------

The real problem is that a sustainable system requires hard choices. People are so horrified that they need to make the choices that they refuse to make any choices. The ultimate consequence is that the system will collapse and they will no longer need to make choices because they will have none.

Hard choices are made every day. My mother-in-law died a couple of years ago at 74 years of age from cancer. They tried some chemo and one course of radiation and then the doctor basically sat her down and told her that there was no point in pursuing these treatments. Doctors do this every day. They do not simply throw every procedure in their arsenal at someone at that age. In the end, they also put a shunt in to make her more comfortable (a purely palliative procedure). At the end of the day, the doctors control the switch. Underlying your whole thesis is the basic statement "We can't trust doctors, the accountants should make the decisions."

[Oleg Bach]

Hate being part of the population on the verge of 60 - as in youth you think nothing will happen to you - that you are immortal and will never grow old wrinkled nor die - but ... It seems there is no escape - and here I am _ I was just 25 a couple of years ago it seems. I did nurse my father when I was 18 as he slowly died in a bed we put in the dinning room so he would get to view the house and not lay alone in a bedroom.

My mother was another matter - she lived a lot longer and advocating for her along with driving her about and watching that doctors did not dispatch her sooner than naturally determined. It was disturbing watch a great and powerful matriarch driven slowly into the grave...to change the diapers of your own mother is certainly a maturing turn around in life - I also took care of my dying father inlaw - His family were moritfied and cowardly when it came to death _ This care giving was easier for me than it will be for my children when It comes my time - because unlike my parents I do not have resoures they can tap into ---my parents were established and it was easier _ I am not. Oh well...It won't matter much in the end - will it?

[Wilber]

Healthcare coverage is an insurance program because it has many of the characteristics of a insurance program. The definition of Insurance is Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed and known small loss to prevent a large, possibly devastating loss.. In the Canadian system the risk is borne by the government, premiums are paid by the taxpayer, and Canadian residents are the benificiaries, nonetheless, it is an insurance system.

You should do some reading up on the history of the Canada Health Act. It was never intended to be an insurance plan, many provinces don't even have premiums.

Even basic tenants are subject to change.

Good luck on that one.

There is no need to deny coverage to high risk, it simply needs to be priced according. If a person is of such high risk that they cannot pay the corresponding premium, one way to handle it is to put a cap on premiums (either as a percentage of income or at a dollar amount). For those high risk individuals who cannot pay their premium, coverage can be limited to more basic care.

How decent of you.

Healthcare coverage is an insurance program because it has many of the characteristics of a insurance program. The definition of Insurance is Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed and known small loss to prevent a large, possibly devastating loss.. In the Canadian system the risk is borne by the government, premiums are paid by the taxpayer, and Canadian residents are the benificiaries, nonetheless, it is an insurance system.

Again, it is not an insurance plan, it is a healthcare plan. You can buy a supplementary insurance plan if you want one.

Very few individuals are high enough risk that you cannot cover them. At some point if you have too many people who are high enough risk, then yes you indeed may need to deny coverage.

Who plays God?

[Oleg Bach]

We had a meeting with hospital officals- everyone from the head doctors to the priest and what appeared to be someone with the mind and demenour of an accountant..We discussed my mothers care - Some of them seems preturbed that this strong willed woman simply refused to die - One red faced alcholic doctor was advocating getting rid of her in no uncertain terms - We resisted and insisted that it was up to my mother when she decided to let go. A few months later I suppose the accountant type got his way..behind our backs they shifted her to another facility - then notified me that she was dead...My youngest brother was the last to see her - He said to her "MUM it's okay to die now." With this permit she instantly took her last breath...I was pretrubed because while I was away they dehydrated her and sped up her demise.

[Oleg Bach]

Better teach your kids now on how to advocate and protect you from the big machine that will gobble up your brittle bones..If you actually think that some immigrant health care worker or "care giver" is not going to abuse you in your old age - you might have another thing coming. The situation will not be one extended tribal family taking care of their elders - but strangers to the tribe who will NOT give a damn for the dying privledged class as they will percieve them in tacit contempt.

[bush_cheney2004]

....If you actually think that some immigrant health care worker or "care giver" is not going to abuse you in your old age - you might have another thing coming.

Gee....you're taking all the fun out of digital extraction!

[Oleg Bach]

Gee....you're taking all the fun out of digital extraction!

The powerful old boys and girls club will soon pay the price. They demanded that no one breed unless they could afford it..They condomned the youth to death through threat of sexual disease and death - They systemically gayified males and feminized females to hold breeding males in contempt and loathing - NOW they complain that the birth rate is low - that there are no young people to take care of the old and dying - be careful what you dream.

[Oleg Bach]

LOOKS like the people who created the policy that lead to lower birth rates were very rich and could hire good help when they are aged and frail - most of us are not in that postion and will have to settle for having those we do not know or identify with change our diapers and administer that fatal doze of morphine. This buisness of making it difficult to bring children into the world was not such a good idea in the long run...where are the 20 million that should have been born? Don't expect a brown lady from Shrilanka who just got a cheeze ball degree in patient maintainace to be kind to you if your name is Smith.

[Bonam]

Life expectancy has been skyrocketing for decades so of course the retirement age will have to be increased. More and more people will be working til 70, 80, or even 150. Trends in the growth of life expectancy show no sign of stopping or slowing down. Why should you retire at 65 if that is only half way through your life?

The earlier point someone brought up about living to 200 with increasing medical technology is a good one, because it is something that will become feasible in the near future. We are on the verge of the widespread application of biotechnology and nanotechnology to medicine which will have a tremendous impact on life expectancy, if not attaining the goal of negligible senescence outright.

[Renegade]

I can almost guarantee you that any ailing 97 year old is not going to receive under any system any more than palliative care. Your argument is a classic example of a fallacious argument from a false continuum.

You are misinterpreting the definition of a fallacious argument. Look it up. Fallacy.. In addition my argument is not a false continum, as I do not state that a suitable line of decision cannot exist because of the continuum of possibilities. What I state is the line must exist somewhere between what we agree are resonable decisions and the extreme cases I have described. My question to you is where do YOU draw the line?

And I'd argue that many procedures are only expensive because of a relative scarcity of doctors willing to do them. The best way to bring down costs is to increase the number of such procedures. Open heart surgeries, for instance, were spectacularly expensive fifty years ago because the ability to find a surgeon was so difficult, and the general requirements were so great that only larger or well-endowed hospitals could hope to have the resources to assemble cardiac teams. By your system, we would in fact be in a situation where such surgeries would still be extremely rare, simply because we draw the line based on the cost of a procedure now, thus all but wiping out any ability to cheapen the procedure. Since the system no longer has any built-in financial or medical need to innovate, we'd stop dead in our tracks.

And I'd argue that as many procedures become cheaper, many more will emerge which are very expensive. Your argument that the cost of medical procedures goes down is partially true, but it is more than offset by the insatiable appitite for more and more complex procedures and drugs which escalate the price of medical care.

Over time the cost of medical care has gone up with time, not down, because the standard has constantly gone up.

Again, you're asking fallacious and leading questions here. Obviously no medical system, even a private insurer one, is going to make such a procedure generally available. How about something more moderate, like, say, a procedure that reduces child mortality rates? You know, like vaccinations. It's not as if medical systems in the industrialized world haven't had to deal with newer procedures that cost considerable amounts of money up front.

You have come around to what I propose. Yes it seems reasonable that medical procedures like vaccinations are provided for because the benefit is more than worth the cost. This is exactly what I am suggesting. Medical procedures need to be qulified to determine if the benefits are worth the cost. In some cases a specfic procedure may make sense in the case of one individual but not for another.

So the only measure of medicine is financial cost?

No but it is one measure. Effecitveness is another.

Hard choices are made every day. My mother-in-law died a couple of years ago at 74 years of age from cancer. They tried some chemo and one course of radiation and then the doctor basically sat her down and told her that there was no point in pursuing these treatments. Doctors do this every day. They do not simply throw every procedure in their arsenal at someone at that age. In the end, they also put a shunt in to make her more comfortable (a purely palliative procedure). At the end of the day, the doctors control the switch. Underlying your whole thesis is the basic statement "We can't trust doctors, the accountants should make the decisions."

The proof is in the outcome. Our system has been in place for many years, yet medical costs keep esclating. Leaving it to doctors and patients alone is not sufficient to contain costs. The demographic shift will only amplify this problem.

Edited February 23, 2010 by Renegade

[Oleg Bach]

Doctors should not equate practicing medicine with being millionares. In a more civilized era - doctors worked as such out of benevolence not profit.