Wednesday, August 19, 2009

End of Life

[From Joel] I agree that there's too much going on in the previous post. Let's look at a single issue. What are the expenses that occur in the last phase of life? Does it make sense to try to cut expenses using some universal formula? Here's a web site that addresses the salient statistics and issues.

with respect -Joel

P.S. That's me, a seventy year old, climbing a wall on July 4, 2009 celebration. The National Guard guys who haul the wall around say I hold the old age record for climbing the wall. Hopefully I'll take a swan dive off a cliff when the government starts to evaluate my quality of life for medical treatment.


Ira Glickstein said...

Great to see you, 70-years-young like me, climbing a wall last month! Save that photo - when the "quality-adjusted life years" (QALY) part of the health care reform program kicks in, the fact you can climb walls will raise your score by 10-20% :^)

I followed your link and the link from there to the government report that says that around 30% of MEDICARE dollars are spent on the last year of life. (Actually, the report dates from 1999 and says 1994 was 26.5% and 1999 was 27.9%, so I guess the 30% estimate was based on the number continuing to rise.)

Of course the problem is that this is 30% of MEDICARE spending only, which almost all goes to people 65+. The 50% estimate I read about, and the 80% number suggested by President Obama, is the percentage of TOTAL health care dollars, from birth to death.

There is also a problem with the linked site because it claims Terri Schiavo's husband kept the money won in the court case and withheld treatment. That is simply not true. In any case, the site you linked to confirms that Schiavo's brain was mostly liquid, with very little working brain tissue. The Schaivo case was one where I broke with some Republican politicos. The case was decided by the courts and the feds should have stayed out of it totally.

That said, there is much good info about end-of-life strategies in the link you provided. One I like is the idea of free hospice care for those over 90 plus a $30K bonus if they choose only palliative treatment. I would change it to free hospice care if quality of life falls below a certain level, rather than peg it to age. For example, if you Joel, are still climbing walls at age 90 you would not qualify!

Ira Glickstein

joel said...

I take what might be called a Libertarian view of this subject. Calculations by some central authority of the quality of lives smacks of the most horrible of dictatorships created in either fact and fiction. I like solutions that maximize the freedom of the individual to make choices. Societal considerations should be secondary.

For example, many people get term insurance instead of whole life. The premiums are much less. Imagine that health insurance could be bought as term insurance. The benefits of the insurance would diminish at an age to be determined by the insurance purchaser. The price of the policy is determined by actuarial tables not a government committee meddling in questions of quality. When the term insurance runs out only a palliative safety net remains. Today people who intend to linger as long as they can, pay the same premium as those who refuse heroic measures and have living wills. That's not fair insurance policy nor is Medicare itself.

Ira Glickstein said...

Joel, I too distrust "central authority" but it is a fact of life that we have government-funded Medicade/care paid for out of your taxes and mine. Therefore, at least for that part of health care, we need a central authority to determine how to best spend that money. Even our "private" insurance has, for each insurance company, rules to regulate how funds are disbursed. In my case, the company I worked for decided, about 15 years ago, to cap their contribution to the health insurance my wife and I depend upon, with the remainder to be paid by we insured individuals. Each year our premium has gone up, so I would like the "central authority" at our insurance company to put some QALY-like system in place to save me money.

I would like government-funded care AND private care to offer the types of choices you suggest where those, like me, who want only palliative care when our quality of life declines below some reasonable level, would pay less in taxes (or premiums), and those who want "heroic" treatments to postpone death as long as possible will pay higher premiums.

How do you suggest we establish such a system?

Ira Glickstein

JohnS said...

Joel, sorry I posted my blog before reading yours although we seem to come to similar conclusions. John