stitchmd asked me to write this diary, so I will. As most people on this blog know, my father is a health economist, and often gets published in Health Affairs. He does numerous studies on end-of-life care, so I often get information from him.
Ellen Goodman, in her column last Friday, ably points out the two most salient facts about end-of-life care:
- 25 percent of all Medicare dollars are spent in the last year of life, much of it in the last month.
- Patients who go into hospice care have a greater life expectancy than those who choose to undergo aggressive treatment.
Think about this, folks. A little over $100 billion a year (the cost of the House tri-committee and Kennedy/Dodd universal health insurance plans) of our taxpayer dollars are going to the last year of life of Medicare beneficiaries, and we have nothing positive to show for this. And yet Max Baucus, who to his credit courageously and successfully led the opposition to Sen. Kyl's amendment to bar the use of comparative effectiveness research in public programs, wants to do nothing about this subject.
Now some folks claim this is rationing. Well, the fact is like every other country, we already ration health care. We just ration health care the same way we ration fancy cars, beachfront property, and everything else -- by ability to pay.
What is the result? We force an uninsured 45-year-old administrative assistant with severe chest pain to work through the pain because she cannot afford the surgery -- all so we can spend $200,000 on some 88-year-old Medicare recipient with Alzheimer's to extend -- with no guarantee -- his life another few months. We force an uninsured child born with heart problems to forgo the necessary treatments until he goes to the emergency room so we can spend several hundred thousand dollars on a 90-year-old Medicare recipient's transplant. We force an uninsured carpenter to work through a bad back because he cannot afford the surgery -- all so we can resuscitate a 93-year-old Medicare recipient. We force 47 million Americans to go without health insurance because they cannot afford it -- all so Medicare recipients can get exorbitant experimental treatments trying to prolong hopeless lives.
Does this seem like justice to you? It doesn't to me.
Now some people will claim this is murder. It's no more murder than when a fireman rescuing people from a burning building lets the 85-year-old lady die because he doesn't have time to rescue her. Fireman have to ration their time, and place an economic value on life, so they first rescue those whose lives we value the most. On health care, we have to ration our money, and place an economic value on life.
The fact is that everyone is going to have to sacrifice if we want universal health insurance. And that means seniors, too.