How to Lower Healthcare Costs Without Cutting Providers’ Wages or Reducing Services

by Dave Schuler on January 25, 2013


{ 15 comments… read them below or add one }

Icepick January 25, 2013 at 8:34 am

LOL! Brilliant!

Icepick January 25, 2013 at 8:35 am

I particularly like the second paragraph.

jan January 25, 2013 at 9:57 am

….completely fooled! Nice, Dave. It’s makes your point seamlessly.

Steve January 25, 2013 at 10:59 am

Agreed, though I would make it and instead of or if we are talking about the kinds of cuts we really need.


jan January 25, 2013 at 11:06 am

This article amplifies your’s: Easy Choices on Health Care: There Aren’t any.

jan January 25, 2013 at 11:17 am

Another related health care cost — end of life care — philosophically discussed —> When It Comes To End Of Life Care The State Does Not Love You.

Andy January 25, 2013 at 11:48 am

Lol, nice!

PD Shaw January 25, 2013 at 11:51 am

I can’t believe the Glittering Eye has stooped to posting pictures of topless women to draw traffic.

Piercello January 25, 2013 at 1:02 pm

Shades of John Cage.

steve January 25, 2013 at 9:47 pm

@jan- I have only been working in the field of medicine for about 40 years, 27 as a physician, a short time in the scheme of things. That said, the article you cite is so wrong, the author so clearly ignorant of end of life issues, it is sad. If I set out to deliberately lie, I am not sure I could write something that awful. Why dont you find some people who know what they are talking about? End of life issues are complex. If you care, I suspect this is just point scoring, go read.


jan January 25, 2013 at 10:00 pm


The end of life article posted was described as a philosophical discussion of the topic, not a spot-on serious undertaking of the issue. It was interwoven with pro-life references, as well as scattered with perceived left/right perspectives. One legitimate ‘factoid’ was the controversial Liverpool Care Pathway, a program derived from England’s NHS which has had a lot of negative press recently.

steve January 26, 2013 at 3:41 pm

Fantasyoid would be the correct term. I know a fair bit about the LCP. I have been a consultant off and on for hospice care. The LCP is just a guideline for best practices at the end of life. Once on it, it takes constant monitoring and people can be, and are, taken off of it. This is just part and parcel with the same claims that the UK does not provide dialysis on people over 60. Of course, a lot of right wingers are hostile towards hospice care also. On one hand, you guys dont want anyone doing anything that might result in less care. OTOH, you want to lower costs. Good hospice care has generally been shown to lower costs, often providing less highly invasive care, while letting people live longer and in less pain. Both pts and families score as being much happier with the care.

Cant have that can we? Much better to spread uninformed lies that conform to a political narrative. Ordinarily I dont care, because that is how politics works, but I really hate having to torture old people to death.


jan January 26, 2013 at 8:17 pm

Of course, a lot of right wingers are hostile towards hospice care also. On one hand, you guys dont want anyone doing anything that might result in less care. OTOH, you want to lower costs

Steve, I don’t know where you get off with some of your mindless accusations. Right-wingers hostile towards hospice!!!! That’s ludricious as well as baseless, and is nothing more than a cheap political shot!

The following are a couple of articles addressing LCP in the UK, which disagree with your assessment:

Bad press over Liverpool Care Pathway

…. the widely used protocol for the care of dying patients that has been branded “euthanasia by the backdoor” in some sections of the press, has scared patients and their families and made some doctors reluctant to use it, experts in palliative care have said.

Here is another piece asserting that some 60,000 patients are involved with this end of life care — the most troubling claim being that it is often done without their consent. Also, “A third of families are also kept in the dark when doctors withdraw lifesaving treatment from loved ones.”

The pathway involves withdrawal of lifesaving treatment, with the sick sedated and usually denied nutrition and fluids. Death typically takes place within 29 hours.

It found many patients were not consulted despite being conscious when doctors decided on their care.

Records from 178 hospitals also show that thousands of people on the pathway are left to die in pain because nurses do not do enough to keep them comfortable while drugs are administered.

An estimated 130,000 patients are put on the pathway each year.

Concerns have been raised that clinical judgments are being skewed by incentives for hospitals to use the pathway.

This procedual way to die is subject to rash and even unethical practices, IMO, unless it is scrupulously monitored. And, it has less to do with political leanings, than simply keeping a civilization humane in it’s endings. Late and live-birth abortions have certainly torqued the ‘beginnings’ of life.

jan January 26, 2013 at 8:27 pm

” Much better to spread uninformed lies that conform to a political narrative. Ordinarily I dont care, because that is how politics works, but I really hate having to torture old people to death.”

Old people can be tortured when doctors don’t give a damn, pronouncing death sentences on patients while they’re conscious and very much aware of what’s going on.

I’ve had familty members die in hospice programs that were wonderful. I had an older friend, my ‘second’ mom die a terrible death when her respirator was turned off, as an end-of-life measure. She was fully awake, but couldn’t talk. No one in her family nor her physician told her what they were going to do. I had to kneel at her bedside and talk to her, as she trusted me (even though, I couldn’t stop what was happening because I wasn’t related to her.) Her family left. Her doctor left. And only me and a loyal friend remained at her side as she turned blue and died. I still cry over how terrified she was……

It was not the proper way to go. Oh, did I happen to mention that they also botched her morphine dose!

steve January 27, 2013 at 10:29 am

Most people end up getting too many, often painful, procedures at the end of life because they have not talked it over ahead of time. The patient and the family dont know what is wanted, not having talked it out ahead of time. The default then becomes “do everything”. The advantage to having a Liverpool protocol (LCP), is that you can offer a best practices guideline. Families and patients can know that they will be offered care that is the best that we think it is appropriate for their situation.

This will involve judgment, both in starting the LCP and maintaining it. Where there is judgment, there will be error. People see the errors and want to ditch the LCP. However, that means we default to “do everything” with its broader set of errors and, usually, worse outcomes. (You have already seen how without the LCP people can engage in practice that may not have been appropriate.) Note that the LCP has been modified since its inception. We will, I hope, find better protocols as we go along, but for now it is one that works for the Brits. There will always be a group of docs who will balk at guidelines. I suspect there were pilots who initially objected to the protocols they instituted. As long as docs recognize that guidelines are not manacles, that they still require judgment, they will be able to use them to provide the best level of care currently available. For pts, that means less pain and longer lives with better endings.


Leave a Comment

Previous post:

Next post: