Sunday, August 08, 2010

CBS 60 Minutes presents the cost of "end of life care" issue and hits hard

CBS 60 Minutes tonight presented a report by Steve Kroft, “The Cost of Dying: End-of-Life Care: Patients ‘ Last Two Months of Life Cost Medicare $50 Billion Last Year; Is there a better way?” link here. (The CBS video may resolve properly only in Internet Explorer.)

This report mentioned hospice as if it were obscure to most people.  It also presents dying as inevitable for everyone as a result of biological senescence, so dying badly can be worse than dying inevitably.

There is a web extra about staying at home in the last days, here.

The main report makes the point that the health care reform this year ("Obama care" as conservatives call it) did not address the cost of eldercare during the final months and the desperate attempts to cling to life at all costs. (It did provide some resources for community in-home care and made changes that arguable indirectly help Medicare.) All European countries, with national systems, limit how much can be spent in the last months of life given certain ages and conditions. That’s “rationing” but what we do is still unpredictable rationing.

Kroft interviewed Dr. Ira Byock at a medical center at Dartmouth in New Harmpshire. He said we need to develop “morally robust” ways to face the inevitability of death for all of us.

Update: Aug. 11

On p. 56 of the July-August 2010 issue of Mother Jones, there appears a long article by James Ridgeway, "Meet the Real Death Panels: Should geezers like me give up life-prolonging treatments to cut health care costs?", link here.  I found it with Bing; Mother Jones hasn't indexed it yet into its own site. He discusses the inconsistency of bioethicist Daniel Callahan (apparently not the David Callahan of "The Cheating Culture"), discusses the QALY calculation  and concludes "Here, then, is my advice to anyone who suggests that we geezers should do the right thing and pull the plug on ourselves: Start treating health care as a human right instead of a profit-making opportunity, and see how much money you save. Then, by all means, get back to me."

If Medicare (or as in Britain, the NHS) denies coverage over QALY "rationing" should family members be put in a moral bind and be expected to foot the bill themselves "if able"?  There is no end to this.

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