Posted on 02/27/2005 8:40:41 AM PST by traumer
THOUGH Social Security's fiscal direction has taken center stage in Washington of late, Medicare's future financing problems are likely to be much worse. President Bush has asserted that the Medicare Modernization Act, which he signed in 2003, would solve some of those problems - "the logic is irrefutable," he said two months ago. Yet the Congressional Budget Office expects the law to create just $28 billion in savings during the decade after its passage, while its prescription drug benefit will add more than $400 billion in costs.
So, how can Medicare's ballooning costs be contained? One idea is to let people die earlier.
For the last few decades, the share of Medicare costs incurred by patients in their last year of life has stayed at about 28 percent, said Dr. Gail R. Wilensky, a senior fellow at Project HOPE who previously ran Medicare and Medicaid. Thus end-of-life care hasn't contributed unduly of late to Medicare's problems. But that doesn't mean it shouldn't be part of the solution. "If you take the assumption that you want to go where the money is, it's a reasonable place to look," Dr. Wilensky said.
End-of-life care may also be a useful focus because, in some cases, efforts to prolong life may end up only prolonging suffering. In such cases, reducing pain may be a better use of resources than heroic attempts to save lives.
The question becomes, how can you identify end-of-life care, especially the kind that's likely to be of little value? "It's very difficult to predict exactly when a given individual is going to die, in most cases," said David O. Meltzer, an associate professor of medicine at the University of Chicago who also teaches economics. "But there's no question that there are many markers we have of someone who is approaching the end of life."
Even with that knowledge, however, Dr. Meltzer warned against putting the brakes on care just as a patient takes an inexorable turn for the worse. Studies of doctors who intervened at that point to stave off unproductive care have found little success in cutting costs, he said. Instead, he recommended that doctors try to prepare patients and families for less resource-intensive care at the end of life. "There is no question, as a clinician, and as a patient and the family members of patients, there are things you can do to make sure that expenditures with little chance of being helpful won't be undertaken," he said. "You explain to people that the goal of medical care is not always to make people live longer."
Explaining that principle early on could make a difference in the cases that appear to pose the biggest problem: those in which the patient's health changes suddenly and severely. Dr. Wilensky cited recent research showing that these cases incurred high costs with scant medical benefit.
"When someone starts going south, and there was not an expectation that that was going to happen, you probably pull out all the stops," she said.
These choices can actually harm patients, contradicting the purpose of the treatment, said Dr. Arnold S. Relman, a professor emeritus of medicine and social medicine at Harvard and former editor in chief of The New England Journal of Medicine. "Sometimes, you know that death is inevitable over the next few weeks or few months," he said. "And then there are some doctors, and some families, who just don't want to confront that, and feel that they want to and should invest everything possible - the maximum amount of resources - in fighting the inevitable. That often results in prolonging the pain and discomfort of dying."
Dr. Wilensky said these cases often involved an unusual number of specialists and other doctors visiting the patient, as well as a potentially excessive number of tests. Better coordination of care within hospitals and with other providers could curtail these extra efforts, she said. She also suggested that more use of evidence-based medicine, in which care is guided by documented cases and statistics, could discourage doctors from pursuing treatments with little chance of success.
Ta-Da!
Wow. This must be the year that the came out of all its closets.
There's an interesting career mixture.
Let them die earlier? Good grief, isn't that Michael Schiavo's idea? I think we are entering into dangerous ground here with such a suggestion. What is needed is to let the RX plan go and stop it now and stop paying for unnecessary procedures such as stomach stapling and RX such as Viagra.
You don't think she mentioned that to him do ... Nah ... couldn't be.
The reason Terri needs to die is because her success and life will be a huge obstacle for the "new society" of healthcare savings that they are trying to establish.
But that won't give them all the kidneys and hearts to play with and become god with.
I'll bet he just loved the movie, MILLION DOLLAR BABY.
This ought to make the younger generations thrilled at the prospects for them.
What goes around comes around--BEWARE.
But don't die until they resurrect the death tax.
There's clearly more behind Terry's case than Michael Schiavo's guilty conscience or greed. There is political clout coming from the euthenasia backers, and I am willing to wager -- sadly -- that the invisible force behind it -- the earthly one, that is -- is the insurance lobby. so much of what is egregious and plainly evil in legislation these days seems to play directly to the interests of insurance companies. Where money is concerned, there are no coincidences.
YES. Thank you.
Why don't we just create a decree, to send everyone, when they reach the age of 65 into a "disintegration chamber"
There was a Startrack episode like that.
The problems with both Medicare and Social Security would be solved immedately -- of course we would expect younger people to keep paying into that their entire working lives.
(/sarcasm, of course)
Considering that Medicare only kicks in, when people reach age 65, when they start to get various ailments, of course they need a lot of medical treatments. And who is to say when to start witholding medical care from them.
I can see, that the doctors shoudl educate people, that if someone is 88 with cancer, which is 80% fatal within a few months, it doesn't make sense to further put them through the suffering of radiation treatments and chemo, but it should always be the decision of the patient and their families.
I know a lady, who got breast cancer at age 83, but otherwise was healthy and active, she was treated agressively, recovered, and is still alive, I think she is not 88 or even more.
So, who is to say, who should be treated or not.
Some ten years ago I was shocked when a physician sat down and explained to me how Medicare had slowly taken over. By dictating which and how much in reimbursement expenses were allowed, and being over 50% of those remibursements, healthcare is now financially a function of Medicare.
The state owns our right to healthcare.
Let Hillary come in after this term and this country will, indeed, be a brave new world.
Not to worry, this is why we now have bioethics committees, and why palliative care has been groomed to become a specialty all on its own.
And why they are debating changing the definition of death, and why they are talking about allowing organ donors to donate before death, presumably by being taken to the operating table, having their organs pulled, and then being allowed to expire on the table with nothing left inside of you.
Fine. How about we kill averyone over 30?
I remember a TNG episode like that. I think we should kill everyone off at 30. After all, there's no way to know if a 29 year old is approaching the end of his or her life, so why prolong it?
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