Congress is afraid to talk about the critical issues, like how much can we reduce the money we spend on health care. The obstructionists in both parties refer to this as “rationing”, which serves their real interest, protecting the current system, and preserving the flood of cash that system gives them.

In this post, I tried to estimate the amount of money we could save in a public option that looked like a standard insurance company but was operated by the government, without the pressure to produce ever-increasing profits demanded by Wall Street and rich investors. The numbers are big, but the real money is changing the way we provide health care.

One major part of the financial picture is more efficient treatment. David Leonhart of the NYT tells us about five different treatments of prostate cancer, ranging from “watchful waiting” to several kinds of radiation therapy to treatment with a proton accelerator.

Some doctors swear by one treatment, others by another. But no one really knows which is best. Rigorous research has been scant. Above all, no serious study has found that the high-technology treatments do better at keeping men healthy and alive. Most die of something else before prostate cancer becomes a problem.

In a similar vein, Atul Gawande, in the New Yorker, discusses the different motivations of providers around the country, focusing on the amazing differences between the Mayo Clinic and the town of McAllen, TX, and trying to explain this:

In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

This tells us that one crucial area for the public option is a fully funded and extensive program to study and make decisions about best practices, and a mandate not to pay for other treatments unless there is a demonstration of a benefit to a particular patient.

Another crucial issue is end-of-life care. From Reuters:

The one in 20 Medicare patients who die each year use up almost one-third of expenditures by Medicare, the government health insurance program for the elderly and disabled.

One third of expenses in the last year of life are spent in the final month, according to the report, with aggressive treatments in the final month accounting for 80 percent of those costs.

People who choose non-aggressive treatment spend substantially less. And this is a realistic choice. Jane Gross in the NYT gave a moving description of the choices made by a community of aging nuns.

On average, one sister dies each month, right here, not in the hospital, because few choose aggressive medical intervention at the end of life, although they are welcome to it if they want.

“We approach our living and our dying in the same way, with discernment,” said Sister Mary Lou Mitchell, the congregation president. “Maybe this is one of the messages we can send to society, by modeling it.”

This is a community we can all learn from, just as so many of us did in our early years.

No one thinks medical treatment is fun, and no one wants to waste money on it, at the end of our lives or in the middle. The health care industry has persuaded all kinds of people that it can accomplish much more than it truly can. Education about the wisdom of treatment at all stages, both for physicians and patients, is the best thing we can do to insure lower costs.