August 17 2009

Foolish Spending on Health Care at the End of Life

Carrie L. Lukas

In the New York Times, Richard Dooling, a former intensive care respiratory therapist, writes about the wasteful spending that often goes on in treating those who are near the end of their life. He writes:

I remember marveling, along with the young doctors and nurses I worked with, over how many millions of dollars were spent performing insanely expensive procedures, scans and tests on patients who would never regain consciousness or leave the hospital.

When the insurance ran out, or Medicare stopped paying, patients and their families gave the hospital liens on their homes to pay for this care. Families spent their entire savings so Grandma could make yet another trip to the surgical suite on the slim-to-none chance that bypass surgery, a thoracotomy, an endoscopy or kidney dialysis might get her off the ventilator and out of the hospital in time for her 88th birthday.

His piece is interesting and makes some important point.  Undoubtedly, one problem with our third party payer system is that, for the most part, it shields us from the full costs of the health care we consume, which makes it easy for people to opt for expensive care that doesn't make that much sense.  It certainly makes sense for doctors and others to try to education patients, and the public generally, about the limits of what even really expensive treatments can do for us.  It's probably a healthy thing as a society for people to talk more openly about the inevitability of death and to consider tradeoffs--including cost--about attempts to buy another month or two of life when you are already 90 years old and in pain.

I think few would disagree with this.  Yet the big question is who should make such decisions?  The government or individuals?  Those on the left will scoff at the idea that "individuals" is the other option since right now its insurance companies that make many of those determinations.  Yet your relationship with an insurance company is a contract.  If we had a more robust insurance marketplace (for example if regulations allowed the purchase of any coverage from around the country and if the tax treatment between individual and employer provided insurance was made equal) then people would be shopping for specific contracts and would be more familiar with the cost-and-care tradeoffs. What makes people nervous (and rightly so) is that idea that government would be charged with making these determinations so that it becomes a decision without regard to personal situation.

Dooling writes of those mortgaging homes to pay for unnecessary care. I firmly believe that that is any individual's right to spend her last dollar on medical care.  But I can't believe that people are so wholly irrational that  many would spending all their money on totally poiintless operations for those who are over 90.  I trust the individuals and wish policymakers would focus on empowering them while reforming health care.

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