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will overtreatment of the terminally ill bankrupt america?

For those of us who saw a re-run of a "60 Minutes" piece last weekend titled "The Cost of Dying: End-of-life-Care watch here  for a summary of its content. For those who did not consider the following.  We spent $55 billion last year in Medicare payments made to doctors and hospitals for treatment rendered to those who are suffering through the last two months of their lives. That's more than the budget for Homeland Security or the Department of Education. The cost of treating the terminally ill will bankrupt America unless out-of-control health care costs are contained. This according to David Walker the former head of the GAO (Government Accountability Office). Why are we spending this much money on those who cannot be saved? Well it should be no surprise that doctors and hospitals get paid based on the number of patients they see or admit. According to Dr. Elliot Fisher, a doctor who specializes in treating the terminally ill, about 30% of all hospitalizations for these patients are unnecessary. Not only that, but once an elderly patient is admitted, testing and screening occur at blazing speeds. Procedures are done which are questionable, like one instance where a 90 year old patient received a $40,000 defibrillator. Another case is cited where a dying woman received a PAP smear. The news story reported that the average cost of a patient receiving terminal care is $10,000 a day. According to Dr. Fisher, we have become so good at treating the complications associated with dying that we can keep people alive for months or in some cases years.  The other question is of course what about the quality of life? That's another story. Apparently, if a patient requests that a recommended test or treatment be performed Medicare is obligated to pay. This is the only country in the world that imposes this kind of tax burden on the living. Who wants to be the one that says, "pull the plug on grandma"? The sad reality is that we will not have the money to continue these kinds of unnecessary treatments to the millions of baby-boomers who will be heading out the door in the next 20 years (myself included). Interestingly, the new medical care act does not directly address this problem. Why does a 90 year old woman who is dying need to have 13 costly tests administered upon admission as one daughter who was interviewed confided? If a doctor orders a test who among us is going to challenge his or her order? Most likely - very few of us. Most people, according to the piece, never closely examine the doctor or hospital bill.  Most of the time it's just a notice of payment made. Even though most people who were interviewed say they would prefer to die at home, the actual statistic is that 75% of us die in hospitals or nursing homes. The moral question will continue, but the economic question will not wait. I have blogged in the past about doctors and hospitals committing errors because of unnecessary testing, but this goes far beyond that issue. This is about making hard life and death decisions about those we love the most. I guess we can say "damn the dollar" and keep her alive for a while longer regardless of the quality of that life: or use that $55 billion a year to care for the 40 million uninsured Americans who not at death's door. David Walker says that if we properly managed the care of these terminally ill patients, the money we would save would be more than enough that we can avoid rationing their care in their remaining days. Tough questions, but ones that we will not be able to avoid much longer. Dennis F Feeley

1 Comment

The report raises serious questions about the health care industry. Dubious decision making motivated by greed.

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