It is a well documented fact that seniors spend tens of thousands of Medicare dollars in their last six months of life. But trying to save some of those dollars through reform is not going to be easy. It is no secret that Congress plans to find fully one third of the dollars needed to cover the millions of uninsured by squeezing the Medicare and Medicade systems.
Trying to determine when the end is near is rather like telling a bus passenger that they should get off the bus six blocks before Elm Street. Even patients with terminal illnesses surprise their doctors and families with frequency. When do you give up on a patient and withhold expensive care? Who will determine what procedures, tests and care are appropriate?
One of the less discussed reforms in both the House and Senate Healthcare bills talks about a Commissioner of the Health Choices Administration, a new government agency. In addition to establishing federal standards for health insurance programs both private and public, this agency and its administrators would eventually be charged with determining standards of care and who gets what and when and at what cost. If it sounds like rationing it is. The difference is that the decisions will be made by unelected government bureaucrats. Many doctors, seniors, insurance executives and hospital administrators have a host of unanswered questions about how this new agency will be built, how it will be staffed and how it will work.
Dctors are not helping the situation considering their reluctance to discuss cost issues with patients. A recent survey appearing in Health Affairs magazine shows that physicians almost always take cost into consideration when making treatment recommendations. The survey showed that oncologists treating terminal cancer consider factors such as a patient’s out of pocket costs and Medicare reimbursement when making a treatment recommendation. But only 43% say that they discussed the cost issues affecting their medical advice.
The simple facts of healthcare reform are that there are no simple solutions. Controlling spiraling costs is a prime motivator of the reform process. But when you strip away all the political retoric it comes down to questions like: How much spending on a termanal health condition is too much? How much are tax payers willing to spend to keep the uninsured alive? What is the economic value of one year of life…one month…one day?
And with or without reform, someone will always have to fill the role of final abitor of treatment.
