Today, the New York Times released a transcript of an interview with President Obama where he spoke about health reform as well as end of life issues. President Obama admitted that one of the toughest discussions surrounding healthcare reform is how to deal with end of life issues:
And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.
So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.
And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.
I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.
http://www.nytimes.com/...
He continues on, talking about the difficulty in raising the issue:
So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
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Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
I believe that these comments are going to be the most noteworthy takeaways from this NYT interview. The media is focused on the 100 day report card stories today, but I guarantee you that Fox News and other conservatives are going to pick this story up and run with it. Remember Terri Schiavo?
With that said, I'm glad that President Obama is laying the groundwork and starting a conversation about this very sensitive topic. If we're going to reduce healthcare costs, then reducing end of life costs is necessary. According to a 2006 USA Today article, about 27% of Medicare's annual budget goes to end of life costs.
While not the major factor driving health care spending, costs involved in sustaining patients in their final days are likely to get a closer look by both Medicare and private insurers as health costs continue to spiral and the population ages.
http://www.usatoday.com/...
I could easily see health insurance companies saying that they will no longer cover the bills for end of life and by President Obama's comments it looks like the federal government may want to get out of the business of covering these costs as well. If we're going to cut costs, I don't see a problem with saying to people that the federal government and private health insurers are not going to provide heroic measures to brain dead people like Terri Schiavo. It may sound harsh, but choices have to be made. If people want their loved one to be put on an inhalator and special care, then they need to pay in cash up front for each day of service provided for their loved one. Again, I know that it sounds terrible to demand cash from a grieving family, but if they don't realize the amount of money that is required to take care of someone at the end of life, then they will out of emotion will implore the doctor to do anything possible to preserve their loved one's life. Perhaps health insurance companies could provide a supplemental policy for end of life costs? It would be incredibly expensive I imagine, but it would allow some middle class people to still obtain end of life care if they wished.
So what do you think? What would be your solution to deal with the HIGH costs of end of life care?