Remember the hullabaloo over so-called “death panels,” last summer? Faced with screeching right-wing opportunists who tried to kill healthcare reform by accusing the Obama administration of being out to snuff out our grandparents, the folks responsible for writing the legislation excised a sensible provision that would have made it easier to stop wasting money on the exorbitant, painful, and often futile tests and procedures that tend to make the last months of Americans’ lives miserable. The provision would have enabled doctors to bill Medicare for the time it takes to compassionately discuss end-of-life options with elderly patients and their families.
I know that if I were terminally ill, I’d prefer a swift death at home to a prolonged entubated stint in the hospital, especially when there are millions of people not on their deathbeds who could use that same care but it’s out of reach for them. I’d also wager that this preference is widespread. Trouble is, this issue defies being broken into soundbites. “Steve,” does a great job addressing it in this Health Insurance Resource Center blog post. Find out way more by reading two excellent yet very long magazine articles: Meet the Real Death Panels by James Ridgeway in Mother Jones, and Letting Go by Atul Gawande in The New Yorker.
Gawande, who is a surgeon, sensibly lays out the dilemma. “Our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.”
In light of this summer’s loud hand-wringing about reining in the deficit, it’s a good idea to look at the cost of allowing the medical industry to keep on poking, prodding, and operating on terminally ill patients that most likely would have a higher quality of life in their remaining days if they were left alone.
“Hard numbers are not easy to come by, but studies from the 1990s suggest that between a quarter and a third of annual Medicare expenditures go to patients in their last year of life,” Ridgway says. “And 30 to 40 percent of those costs accrue in the final month. What this means is that around one in ten Medicare dollars—some $50 billion a year—are spent on patients with fewer than 30 days to live.”
Or as Gawande explains, “Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.”
Fixing the problem would require, Ridgeway says, transforming American health care into a right, rather than a commodity accessible only to people who can afford it. Or, as OtherWords columnist William A. Collins wrote earlier this year, that Health Care Is a Study in Greed.
