Bitter Pill: Why Medical Bills Are Killing Us
[This is a looong article - I've only read part of it, but the stories are very disturbing]
https://healthland.time.com/2013/02/...re-killing-us/
Bitter Pill: Why Medical Bills Are Killing Us
By Steven BrillFeb. 20, 2013
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Corrections Appended: February 26, 2013
1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.
Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.
About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”
Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”
The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was $83,900.
Why?
The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.
(In-Depth Video: The Exorbitant Prices of Health Care)
Dozens of midpriced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.
Every time a nurse drew blood, a “ROUTINE VENIPUNCTURE” charge of $36.00 appeared, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done on Recchi amounted to more than $15,000. Had Recchi been old enough for Medicare, MD Anderson would have been paid a few hundred dollars for all those tests. By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.
On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.
When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”
The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1
The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”
DePinho’s salary is nearly two and a half times the $750,000 paid to Francisco Cigarroa, the chancellor of entire University of Texas system, of which MD Anderson is a part. This pay structure is emblematic of American medical economics and is reflected on campuses across the U.S., where the president of a hospital or hospital system associated with a university — whether it’s Texas, Stanford, Duke or Yale — is invariably paid much more than the person in charge of the university.
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.
The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.
Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.
According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.
The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the U.S. by 2020 are related to health care. America’s largest city may be commonly thought of as the world’s financial-services capital, but of New York’s 18 largest private employers, eight are hospitals and four are banks. Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.
The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.
When you crunch data compiled by McKinsey and other researchers, the big picture looks like this: We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%, more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capita income in the U.S. vs. those other countries. Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance. This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses.
1. Here and elsewhere I define operating profit as the hospital’s excess of revenue over expenses, plus the amount it lists on its tax return for depreciation of assets—because depreciation is an accounting expense, not a cash expense. John Gunn, chief operating officer of Memorial Sloan-Kettering Cancer Center, calls this the “fairest way” of judging a hospital’s financial performance
Article continues at: https://healthland.time.com/2013/02/...-killing-us/2/
Re: Bitter Pill: Why Medical Bills Are Killing Us
Why do they do this? Because they can. Junk food manufacturers refer to customers as "stomach share." PG&E can ignore stats about the deplorable condition of their transmission pipes because we're dependent on their product and don't remotely comprehend how they run their business. I would humbly suggest, *neither do they.* I don't think the Pentagon has a sinister genius plan to rip us all off for $198 toilet seat bolts, I think they don't have the foggiest idea what they're doing, but they have a pretty clear idea how to get the money for it. God bless those who do their best to bring scientific thinking into daily consciousness.
We are confronted daily with massive operations like medical services (let's not call it healthcare), corporate ag, military ops, communication networks, credit cards, banking, incarceration services (!?), and the grotesque thing that our food industry has become -- and we know that something's wrong, but haven't enough grip at the ground level to know how it works, so we don't know how to react to the whopping bills and pervasive toxins.
If I record a radio spot for a friend, and he offers a payment, I have some index, knowing what he'd charge for an hour of therapy. If I know I'll have extra tomatoes in September, I can swap for some help watering when I'll be gone in July. When we're truly connected, we have some idea of comparative worth. When an entire economic structure has put us in a cuisinart and labeled us consumers, we pay what they tell us to pay.
And when our body is on the line, and we are suddenly a *patient,* how do we know what questions to ask? There is no advocate, no ombudsman, no interpreter, nobody to shout, "what the F&*$ is this?!!!" So they do it, because they can. And because it's already happening to us from so many other directions, it's easy to say, OK, that's just the way it is. Somebody wants to drill a fracking well on your land? Good luck resisting.
How do we begin to unravel this? All that occurs to me is that, well, we've got a deadline staring us in the face, a real one. We tip the carbon level in the atmosphere, and we've just written off our grandchildren. We accept GMO's in our food supply, ditto. We deliver every aspect of our body's functioning into the hands of medical profit, ditto.
Just a little while ago, I saw a baby being born. I was there. There were no drugs, there were no interventions, just a strong impassioned team of women who knew how deep the innate wisdom of the body runs, and how to support the fierce courage of the laboring mother. It took a lot of work, it involved pain, and the reward was immense. Others, myself included, had been taken down the "easy" medical route, and were not part of this miracle.
Me, I think we're at the chute to the abbatoir. Whoa, overly dramatic, what? But we're seeing the drought, the wildfires, the superstorms, the food poisoning, the obesity, the asthma, the orgasms of assault weapons, the pollution of the very idea of truth in what passes for journalism. I find it hard to confront the idea of what it may take, to take a stand. But I find it equally hard to wall off the understanding of what's at stake, and how soon. A baby was born. What kind of world will she enter when she herself gives birth? -- Elizabeth
Re: Bitter Pill: Why Medical Bills Are Killing Us
There are a lot of reasons, and that's why it's going to be a rough haul over the next few decades.
First, the biggest factor is that we're a capitalist society (really, a capitalistic world) where the trend is to monetize and marketize everything. So that's the framework that applies when you need health care - you're going to have to pay, and the system's going to be set up so there are profits and income generated, and those who run it will derive their wealth and influence from it.
A second huge reason is that people feel like, since this is often a life & death issue for them, getting access to care is the overriding goal - and one that should be shared by their society.
Thus the rise of a huge medical industry despite the fact that the market model doesn't apply to it. When the first major effort to overhaul the health system began, the insurance companies were able to terrify the voters, or at least appeal to their gut feeling that free-market everything is better than any government takeover, and that killed it. Obama's new system therefore has been designed to avoid triggering similar opposition by only limited changes to the economic structure in place.
It's not a planned system; it's a bunch of ad-hoc solutions that metastasized over time. It's similar to military billing, with the $500 hammer and the $2000 toilet seat. An aspirin doesn't need to be whatever ridiculous price it shows up as. But they do "need" to generate a certain amount from each patient's trip to the hospital, and so they divvy up their charges in ways that are convenient. Of course the market forces that make this sort-of work in, say, a retail environment, don't apply here at all - people won't pick and choose on a micro level, using per-item pricing as a factor. So it shouldn't be so surprising that this system is horrifying and makes no apparent sense. But thinking of it as a problem of overcharging for single services or drugs fundamentally misses the point.
Re: Bitter Pill: Why Medical Bills Are Killing Us
Quote:
Posted in reply to the post by podfish:
But thinking of it as a problem of overcharging for single services or drugs fundamentally misses the point.
Exactly so. Nearly the total cost of hospital care (or most health care) is direct salaries (Doctors, Nurses, Janitors) and salaries of overhead (Managers, Lawyers, Accountants, File Clerks) with some capital costs (MRI, X-Ray, etc). Take a small hospital like Palm, add up all the costs, divide by the patient days and that's the hospital bill. $1.50 aspirin recognizes $1.49 cost to administer each pill.
All ideas of reducing health care costs without either 1) reducing salaries (I'm sure nurses, let alone doctors, will like that) or 2) increasing efficiency (but this is terribly hard to do if you say: saving $100 million dollars at the risk of 1 additional death is unacceptable). If not for one of these two ways, heath costs will not change.
UK and Canada solve the problem by having a moderate health care system (with lots of restrictions) overlaid by a private insurance system for those who can afford it, to get enhanced care. Even so, a hip replacement might take 3 years (here you can get it in 3 weeks...if you have the right insurance).
the real shame, of course, is we could make health care something like 90% better for 90% of the people spending the same amount we do today, but there is no way to prevent over utilization. So we stick with our crazy system.
Re: Bitter Pill: Why Medical Bills Are Killing Us
this problem could be solved with a market approach. health care is a service. think of the care provided which is mostly fee for service, dental, vision, and alternative therapy. if an md did what my dentist does it would cost thousands instead of hundreds. you know this is true. we only need insurance for serious shit. check out the price break for high deductible policys. a market approach would help with more serious illness too. insurance for all health care is the problem not the solution. why should i pay for your bad health habits? preventative care is something we do for ourselves. argue with me... you will lose, and be educated. just check out similar threads, i get the last word : )
Quote:
Posted in reply to the post by spam1:
Exactly so. Nearly the total cost of hospital care (or most health care) is direct salaries (Doctors, Nurses, Janitors) and salaries of overhead (Managers, Lawyers, Accountants, File Clerks) with some capital costs (MRI, X-Ray, etc). Take a small hospital like Palm, add up all the costs, divide by the patient days and that's the hospital bill. $1.50 aspirin recognizes $1.49 cost to administer each pill.
All ideas of reducing health care costs without either 1) reducing salaries (I'm sure nurses, let alone doctors, will like that) or 2) increasing efficiency (but this is terribly hard to do if you say: saving $100 million dollars at the risk of 1 additional death is unacceptable). If not for one of these two ways, heath costs will not change.
UK and Canada solve the problem by having a moderate health care system (with lots of restrictions) overlaid by a private insurance system for those who can afford it, to get enhanced care. Even so, a hip replacement might take 3 years (here you can get it in 3 weeks...if you have the right insurance).
the real shame, of course, is we could make health care something like 90% better for 90% of the people spending the same amount we do today, but there is no way to prevent over utilization. So we stick with our crazy system.
Re: Bitter Pill: Why Medical Bills Are Killing Us
Quote:
Posted in reply to the post by rossmen:
this problem could be solved with a market approach. health care is a service. think of the care provided which is mostly fee for service, dental, vision, and alternative therapy.
No, medical care is manifestly different. If you have stroke, and are found unconscious with your car smashed into a tree, you will be taken, via $1500 ambulance, to a hospital, treated (maybe for days before you awake) and when you do awake, you are presented with a $250K bill. Very hard to apply a market approach. There -may- be a market approach to insurance, but not to medical care.
And, unless we all agree, and stick to the premise, that no insurance means no care (no emergency room service) then there will be a $250K bill that someone must pay.
We pay for public school under the presumption that universal education will benefit everyone, and that has been well accepted. Should health care be under the same umbrella, and with the same risk (where many public schools are extremely poor, especially back east) and those that can afford it pay for supplemental care?
Libertarians would say "don't pay for anything, except maybe a Navy"; Socialists would say "pay for everything that any citizen (or non-citizen) would need". Pragmatists understand that there is a middle path that provides for a sensible and stable society.
Of course, the real danger of public funded health care is that is supports the premise that "if I (feds, busybodies, taxpayers) pay for your health care, I should get a say in how you live your life". We see that already in helmet laws, and bans on 17 oz sodas in NY.
Quote:
Posted in reply to the post by rossmen:
argue with me... you will lose, and be educated. just check out similar threads, i get the last word : )
Of course I would never argue...I might try to reason with you, however.
Re: Bitter Pill: Why Medical Bills Are Killing Us
of course most all of us need insurance for serious injury or disease. the majority of medical visits are not of this nature yet are still covered by insurance. this distorts this market beyond reason and thus the thread title, it is literally true for both quality and cost. and it also disincentives people taking care of themselves. the majority of healthcare $ are spent on lifestyle illnesses. diabetes, which is largely curable, accounts for 1/4 of us medical bills.
the solution is for very high deductible single payer insurance with a means tested program for some. then the market would bring transparency to quality and cost, including visits covered by insurance.
of course this is politically unfeasible because it would eliminate most private insurance business and the attitude that medical care is different than any other service we need. there is also the belief that people can't take care of themselves, though i don't think you hold that one. otherwise your reasoning is deeply flawed.
Quote:
Posted in reply to the post by spam1:
No, medical care is manifestly different. If you have stroke, and are found unconscious with your car smashed into a tree, you will be taken, via $1500 ambulance, to a hospital, treated (maybe for days before you awake) and when you do awake, you are presented with a $250K bill. Very hard to apply a market approach. There -may- be a market approach to insurance, but not to medical care.
And, unless we all agree, and stick to the premise, that no insurance means no care (no emergency room service) then there will be a $250K bill that someone must pay.
We pay for public school under the presumption that universal education will benefit everyone, and that has been well accepted. Should health care be under the same umbrella, and with the same risk (where many public schools are extremely poor, especially back east) and those that can afford it pay for supplemental care?
Libertarians would say "don't pay for anything, except maybe a Navy"; Socialists would say "pay for everything that any citizen (or non-citizen) would need". Pragmatists understand that there is a middle path that provides for a sensible and stable society.
Of course, the real danger of public funded health care is that is supports the premise that "if I (feds, busybodies, taxpayers) pay for your health care, I should get a say in how you live your life". We see that already in helmet laws, and bans on 17 oz sodas in NY.
Of course I would never argue...I might try to reason with you, however.
Re: Bitter Pill: Why Medical Bills Are Killing Us
I would agree that most of could use some sort of catastrophic insurance, but not necessarily everybody.
I know that healthcare and medical care are 2 different things. Healthcare is done by myself, and insurance won't pay for anything that I do to take care of my health like: drive very little-avoid freeways, avoid urban areas and crowded events, get plenty of REM sleep, avoid stressful situations, avoid dangerous work situations, get moderate exercise, don't eat toxic food, don't do toxic pharmaceutical drugs, eat only (for the most part) organic products and learn about herbs, vitamins and supplements, pay for my dental care and have a good outlook and respect life.
So called healthcare insurance does not pay for any of this, that is why I don't waste money on it.
I do pay taxes and that includes Medicare insurance, which hopefully when I can start collecting on my Medicare savings acount (if I do need any medical care), that the account will still be there and not looted by Wall St.
Some people think that since they pay some healthcare insurance corporation $600 to $1000 per month that they are invincible, and can disrespect their health all that they want to because they think that they are "covered" . We call them "invincibles".
Those people add to the high cost of insurance, because their attitude is "since I have to pay all this money every month, I am going to the doctor for anything and everything".
But the truth is, there is no cure for the Rhinovirus (common cold), Influenza, or most pains due to work related injuries, minor back injuries, arthritus and a host of maladies.
All the doctors do is dispense prescriptions for pills, painkillers (narcotics) to mask the symptoms, order expensive tests and scans using high priced medical equipment that often irradiates patients.
That is why healthcare insurance is so expensive, and is a ripoff.
I just saw a friend of mine today, he had to return early from a planned 2 year excursion to Asia.
He said that he had a pinched spine (very rare) due to a work injury done here (lifting heavy rocks and running a jackhammer).
There are only a few specialists in the world who know how to treat this condition. I asked him if he had healthcare insurance and he said no, but this specialist does not take insurance anyway, so he paid for treatment himself. Insurance would not done him one bit of good !
The way the system is set up, it is designed for pure profit only, it is a capitalist/socialist program that has men paying for childbirth, everyone paying for some person who is not happy with their natural born sexuality and needs a sex change, kids who play dangerous sports , doctors who push unnecessary scans and tests, people who don't care about what they eat, untested and toxic pharmaceutical drugs and on and on.
If these"invincibles" want to carry on the lifestyle that they chose, let them, and let them buy expensive healthcare insurance, but I sure don't need it.
Most smart-healthy people don't need much (if any) real medical care until their senior years, and that's what Medicare is for.
Quote:
Posted in reply to the post by rossmen:
of course most all of us need insurance for serious injury or disease. the majority of medical visits are not of this nature yet are still covered by insurance. this distorts this market beyond reason and thus the thread title, it is literally true for both quality and cost. and it also disincentives people taking care of themselves. the majority of healthcare $ are spent on lifestyle illnesses. diabetes, which is largely curable, accounts for 1/4 of us medical bills.
the solution is for very high deductible single payer insurance with a means tested program for some. then the market would bring transparency to quality and cost, including visits covered by insurance.
of course this is politically unfeasible because it would eliminate most private insurance business and the attitude that medical care is different than any other service we need. there is also the belief that people can't take care of themselves, though i don't think you hold that one. otherwise your reasoning is deeply flawed.
Re: Bitter Pill: Why Medical Bills Are Killing Us
Quote:
Posted in reply to the post by rossmen:
the solution is for very high deductible single payer insurance with a means tested program for some. then the market would bring transparency to quality and cost, including visits covered by insurance.
that's not as obvious as you think. It's based on accepting certain assumptions that may not be realistic.
Why is medical care the exceptional case? There's a much lower baseline for what society's willing to provide regarding food, lodging and transportation in comparison to medical care - I should say, emergency medical care, 'cuz health care in a more general sense is hard to get too. I can have heart surgery as an indigent, but I can't get a private room in a shelter??? Frankly, I suspect if I was in that position and offered equivalent cash subsidy for lodging vs. a medical care account, I'd take the lodging. This culture has an unrealistic fear of death, which doesn't seem to be in line with most past or current cultures in the rest of the world. We would be a healthier society in so many ways if we cared more about the comfort and dignity of everyone and panicked less at the end of life.
