Death Panels?

In our present political discourse when certain buzz words or phrases appear, all semblance of rational dialogue disappears.  RADICAL LEFT, RADICAL RIGHT, COMMUNITY ORGANIZER, THE BUSH ADMINISTRATION.  

In health care there is no more loaded phrase than DEATH PANELS, especially for the elderly. Pundits pontificate, visions of Soylent Green appear, and heels are dug in mentally.  What’s the real story?  

The origin of the concerns comes in the initial House healthcare Reform Bill (HR3200).  There was a provision to compensate “counselors” for their time in explaining end-of-life options to patients and their families.  Sounds OK.  This was rapidly followed in the news by the revelation of a Veterans Administration (VA) brochure suggesting to severely disabled and terminally-ill patients that they consider whether they were a financial burden to their families and society in deciding care options.  Hmm, sounds a little ominous.  This was followed at a summer-’09 townhall meeting by President Obama’s now infamous response to a questioner who bemoaned the fact that it was so difficult previously to get a pacemaker for her 95-year-old mother (who was doing well 7 years later):  “. . . sometimes the best therapy is just a pain pill.”  Not so OK.  In fact, sounds downright creepy! 

End-of-life care (defined as the last 12 months of life) and care for the critically ill turns out to be an incredibly important component of cost containment because it represents a disproportionate share of Medicare expenses.  Here’s the core of data we need to consider:  

• 30% of all expenditures in any given year are for end-of-life care
• 40% of all lifetime expenditures for any given enrollee occur in these last 12 months
• 10% of enrollees consume 63% of all yearly expenditures and 5% account for 50%
• Dialysis patients represent 0.8% of all patients but 6% of all expenditures.  

Any meaningful Medicare cost containment will have to address how much and in what manner we deliver care to these patient groups.  Some hard choices will have to be made about resource allocation, and a preview of things to come is seen in the current House and Senate reform bills.  Both set up payment advisory panels to decide what Medicare services will be covered.  They are tasked to use “best practices” and current scientific literature (see previous blogs on Evidence-Based Medicine and Screening Mammograms) in defining the patient populations that would benefit from these services, keeping in mind that “bending the cost curve down” is a primary objective. 


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