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End-Of-Life Preferences Are Key
The old saying that "the devil is in the details" certainly applies to this question. For the elderly, what matters most in health care reform is what lawmakers do about how doctors and hospitals are paid. The Medicare system pays them for activity, not quality of care, so the elderly get a great deal of care, but, like the rest of the population, they get the right care only about half the time, according to a RAND Corporation study. If health care reform drives better quality care, the elderly, as the highest-volume health care consumers, will benefit most.
A courageous part of the legislation attempts to get everyone to document end-of-life preferences. We spend a lot on keeping people alive while they are in extreme pain and discomfort with no hope of recovery, or while they are in comas, without knowing what they would have wanted. My dad lapsed into a coma in July 2001 on a Friday and died two days later. On the day before he died, a nurse attempted to administer a $2,300 injection for prostate cancer therapy. Since he had a living will and my sister and I had powers of attorney, we were able to refuse the treatment. In too many cases, unnecessary care is provided simply because the patient has not taken the steps my dad did.
We should not fall into the trap of denying care to the elderly based on some formulaic approach to the value of an additional year of a person's life. At the same time, we cannot provide any care anyone wants, whether or not it is effective. I do not believe in micromanaging individual patient-doctor decisions, but overall regional incentive payments given to an integrated health-care system will drive doctors to discuss difficult issues in advance with their patients.
By
Michael Critelli
|
August 10, 2009; 10:55 PM ET
| Category:
Doctors
,
Health Care Reform
,
Health costs
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Posted by: klalbert1 | August 16, 2009 8:58 PM
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This is a simplistic comment. No one could disagree with the prostate cancer example, but it doesn't take a 1000 page document and 500 members of congress to come up with this plan. How about a real analysis of what's in the bills...