Ya, screw those who paid into the system, but give a free ride to the illegal aliens. Give a free ride to all those claiming disability that aren't disabled. Give a free ride to everybody except those that paid into the system for their entire life. And when you get old Norm -- screw you!

Are you mad? Knee replacement isn't elective surgery. Getting your boobs enlarged or your face-lifted - those are elective.

Realist: Has nothing to do with illegal aliens or those who claim disability but aren't disabled; you clearly missed the point of the post which, for the second time, is this: 1. we are broke and 2., we cannot afford to invest scarce dollars into surgery for the elderly. This would include non-elective surgery as well, especially heart, lung, cancer, kidney, etc. Of course, if someone is interested in spending their own funds they are certainly welcome to do so.

The purpose of medical care is to prevent premature death and ensure decent quality of life (which interestingly enough joint replacement surgery might help with); it is not to ensure immortality. We're out of funds and decisions must be made where to allocate the resources. You may not like the reality of the situation but there it is, unless you can come up with some facts to repudiate the premise.

Norm903 - Elective? Who in their right mind would "elect" a knee replacement? It's painful and the rehab is grueling. Get a clue. People suffer with knee pain until they can't stand it any longer.

Please write again after you finish high school

Knee replacenment is not elective surgery. It is required to keep functional and thus may prevent more expensive care, such as nursing homes, or keep a person working. It may actually save money in the long-run. I have a bigger issue with young people that destroy their bodies with drugs, smoking, too much food, gun shot wounds, or stupid activities. Why would it be fair to pay for a ACL repair on some young guy that hurt his otherwise healthy body playing football with his buddies but not a 65 with RA that may still still be working or making other contributions to society. This wouldf be "death panels" or a system similar to the one practiced in Nazi Germany. I would not want to judge a person's worth by their health or age.

I really hate when "death panels" are constantly brought up. It is a lame and completely irrelevant assertion.

Health care dollars and resources are finite. There are only so many to go around. It is important that scarce resources be allocated to those who will benefit (in terms of quality of life or longevity) the most.

Didja ever notice what "Hot Lips Holihan did in M*A*S*H as a head nurse. She was in charge of triage. Triage in the medical world is assigning resources to those most urgently needing them. A soldier with terminal injuries beyond a reasonable chance of saving are bypassed in favor of someone who can probably be saved with immediate treatment. Yep, people die in the process. But is that a "death panel"?

The same thing occurs in regular civilian medical care except that money has become the controlling factor in receiving care. A good example of a broken system is Steve Jobs. He had terminal pancreatic cancer. The chemotherapy from treating (not curing) the cancer caused him liver damage. But because Jobs had lots of money and a shortage of seconds of life remaining, he put his money to work. He went on the liver transplant lists of 48 states, often having to rent an apartment of various states (including Alabama) where residency was a requirement. He immediately shot to the top of 11 states' lists. In virtually all of those states he claimed that his panreatic cancer was cured to get past their "patient viability" requirements. He got his liver in Tennessee. Normally a liver is transplanted into 2-4 patients depending on the lobes and blood supply in the liver. It regenerates to full size in a short period. Jobs got a whole liver in his transplant. Then he died from pancreatic cancer.

The problems here are manifold. Obviously money doesn't just talk --- it screams. But if you look at it objectively, Jobs was instrumental in the deaths of 2-4 Tennesseans who could have been recipients of the liver. He should never have received the transplant in the first place because it was never going to prolong his life significantly. He should never have received an entire lives.

But someone has to make these decisions. Someone should have been able to tell Jobs, "Sorry, but you can only be on the California liver transplant list. Sorry, you are not eligible because you are terminally ill and the transplant will not save you. Sorry, but your wealth is not a factor in life-saving medical procedures. Sorry, but giving anyone a whole liver is generally inappropriate. Let us make the end of your life as comfortable as possible, but let's not steal life from other people to do so." I am sure that Jobs would have called it a death panel. But the medical community knows it as triage --- putting scarce resources where they will do the most good.

Of course all resources are finite (MBA 101), but making a decision based on age exclusively is not good business either. One comment here was that once you stop contributing to Social Security, you should not be given resources. Isn't that why we pay into the system for 30, 40, or 50 years, so it will be there when we need it. If we want to start making decisions like that, we should include those who are young, but make the decision to drive recklessly, play sports (not professional) and injure themselves, use drugs, smoke, eat too much, drink to much, have unprotected sex, etc.. In other words, the law of the jungle should be the basis for the decision. While we are at it, what about those that are just unlucky and get sick or hurt or substain brain damage. Is it worth it to spend resources on individuals unless we see a return on investment. These are all versions of a "death panel" if we start applying these criteria. The ultra rich and famous will always play by different rules. Steve Jobs made some bad decisions at the beginning of his illness that led to his death. There have been actors that drank themselves into liver failure and received a transplant. These cases are the exception.

The decision for normal folk should be based on medical criteria, like can they handle the surgery and the rehab to follow, not are they over the age limit for joint replacement.

Reese Roberts - You suggest that bad knees may put people into nursing homes if not replaced. That may be true for some people with severe mobility problems and no social support, but it is not true for the average Boomer with aging knees. I wouldn't suggest that someone with severe pain should not receive the best treatment because they are elderly. However, elderly people are sometimes set on a permanent downhill course by a major surgery. One of my father's friends had a knee replacement; he suffered immediate and serious loss of cognitive function, never recovered, and spiralled downhill into a "care facility." He would have dodged a nursing home, at least for a while, if he had just tolerated the knee pain. Manufacturers of implants and drugs have spent decades persuading us to believe that no amount of natural discomfort is bearable, and nowadays that no modification of lifestyle with age is acceptable. I'm all for avoiding pain, but sometimes it is better to put up with a tolerable pain than have it aggressively treated and risk ending up in a far worse condition.

Chronic pain causes people to less which leads to worsening of underlying issues that most of us have as we age, such as diabetes, heart disease, lung problems, etc.. This can result in a need for a nursing home and hasten death. No normal person wants surgery, but suffering is not the answer. I saw it with my mom. I have seen it with younger people. I have seen the turn around after surgery with friends' parents.

I'm sure the omitted word above is "exercise" - and that's a fair point. Walking frequently is certainly good for you. OTOH, the older you are, the fewer days of life you can expect to gain, on average, from continuing regular weight-bearing exercise, while days spent laid up in rehab after a surgery constitute a larger fraction of your remaining lifespan. Many people do turn around for the better after a major surgery, but a few turn around for the worse or even die, and the older you are, the more likely you are to fall into the latter category. So the likelihood of ending up with a major net benefit must decline with increasing patient age and frailty. I also worry about the fact that manufacturers are allowed to market implanted devices with less testing than is required for drugs that one can (by ignoring one's doctor) quit at will, and some of the expensive new replacement joints are proving to be catastrophic failures that cripple many recipients and may need to be removed to avoid life-threatening complications. One of your arguments above could be reversed as: "No normal person wants pain, but a disastrous intervention cascade is not the answer."

Bingo!! I was waiting to see if the article addressed that. I guarantee you that a good number of replacements are a result of "chronic cardio". Just like our benevolent government's food pyramid caused our obesity epidemic, the cardio craze is causing our joints to fail.

Sorry, JGB, but I emphatically disagree with you. The government food pyramid, however flawed it was/is, did NOT cause our obesity endemic. There are many complex reasons why that is occurring but a picture of a pyramid with little items of food on it is NOT one of them! Likewise, "cardio crazes" are the elective part of the picture. No one forces anyone else to become long distance runners. It is true, however, that prolonged running can damage joints. All of the runners I know have quit after many years of it, and have moved on to gentler exercise, e.g. cycling.

Gemini: We share the same viewpoint regarding the tax code- eliminate all deductions, everyone pays something. Nonetheless, the fact is we're broke and have to make choices. In many cases hip, knee, and other joint surgeries are elective; they are not cases of life or death and while uncomfortable or painful, not required. If someone wants it and can afford it there is no reason not to have the operation, but seriously, what is the payback to society to invest scarce resources in people no longer contributing tax dollars and taking out money from Medicare / Medicaid and Social (In)Security. At a minimum can't we means test and charge more for the services?

Look at unintended consequences of not covering 'elective' knee/hip replacements: the person becomes more disabled and then requires in-home assistance, skilled facility assistance, not to mention to pain they go through. A knee/hip replace is not just a 'oh, my knees are wearing out' moment.

Sorry Norm, but I don't beleive we agree on much of anything. There is no up side to denying knee/hip surgery to anyone that needs it to remain mobile and able to do as much as they can to take care of themselves and continue a productive life! Older retired people do pay taxes. Most people do pay "some" taxes even if they are "poor". Too many people, insist on focusing on the small percentage of people that "cheat" or abuse the system, and base their entire viewpoint on a false premise.

We don't need to eliminate deductions for the working middleclass, but we do need to end the loopholes and un-needed subsidies and write-offs for the upper 2% of the wealthy and corporations that are raking in billions while the average taxpayer is losing 20% or more of their working income and health/retirement benefits.

The Social Security/Medicare problem does need the money restored or replaced that Congress has "borrowed" to fight needless wars and special interest projects ("pork") over the years. There are simple fixes to take care of the shortfalls caused by their recklessness. Top economists have very good solutions to the problem but our "do nothing Congress" has chosen to ignore the fixes and focus on "party superiority" instead of doing the jobs they took an oath to do. Everyone that signed the pledge to the "non-elected" Grover Norquist needs to be recalled and replaced with people that will uphold the oath of office to represent "we the people"!

Oh, I guess we could possibly agree on "means testing" when it comes to eliminating the services of Medicare and Social Security for those in the case of the ultra-rich that can well afford to purchase insurance and/or simply pay for their own medical needs and retirement. I would not wish painful knees/hips on anyone.

granted - True for some, but not others. There's a knee replacement that has been heavily marketed recently, and not just to shuffling oldsters who risk being put in nursing homes if they can't improve their gait. If you have TV, I'm sure you've seen the commercials. It is being pushed to active Boomers with the implication that it will let them keep engaging in activities like mountain hiking right into old age without discomfort. People whose knees hurt when they engage in active sports are not necessarily also in pain when they simply walk (not that many of the active-lifestyle Boomers actually WALK to the grocery store when the SUV's right there anyway). It used to be that if you were sixty years old and your knees hurt like heck when you jogged or played basketball, well, it was time to stop jogging or playing basketball. It's nice that other options are available now, but we're getting to a point where those options are considered the only ones, at least if you're middle-class and insured; the option of accepting even moderate discomforts or limitations with age is increasingly seen as unthinkable. The trouble is that some age-associated discomforts and limitations are not avoidable - ultimately, death - and people who are unwilling to accept any of them risk having an unhappy and expensive last few years.

Retired- Very good points and absolutely correct. Your equation is right on. Too much pain leads to inactivity which leads to weight gain. New knee reverses the process and adds to a productive life. Good job!

I've had both knees replaced. If I hadn't I'd be in a wheelchair full time. Never had a knee injury but I was very active until my knees made me plan how much I could walk before I hurt so bad that even sitting down didn't help. Try waking up in the middle of the night in pain because you moved your leg. For me it was the best thing I ever did.