End-of-Life Care Constitutes Third Rail of U.S. Health Care Policy Debate

A debate about health care just isn’t complete without talking about end-of-life care and the financial stress placed on Medicare’s budget.

Eighteen percent of the total federal spending is taken by healthcare — almost double what other industrialized nations spend. As recently as 2011, Medicare spending edged closer to $555 billion — 21 percent of the total consumed by health care in America the same year. Of that amount, $555 billion, 28 percent, or $170 billion, was spent in the last six months of life.

Leonard Fleck, professor of philosophy and medical ethics at Michigan State University said, “You can imagine someone is thinking, ‘What a waste of money. The argument is that the government wants to save money by denying needed health care to the elderly. The fact is that rationing is inescapable if costs are to be controlled.”

The entire topic was politicized in 2009 in a comment by Sarah Palin — then the Republican vice presidential candidate. Talking about a provision in the Affordable Health Care Act, ACA, that would have provided patients with end-of-life consultations, Palin referred to the service as “death panels”. That comment forced the White House to drop that provision from the ACA.

Palin’s comment was about a valuable and sensible provision that would have encouraged physicians to speak with patients about the consumer’s goal and preference. David Casarett, director of hospice at Penn Medicine Center for Bioethics, said, “It is tough to see anything objectionable about these types of conversations. Yet Palin succeeded in politicizing it for her benefit”.

Sally Pipes, president of Pacific Research Institute said, “I believe the issue of rationed care is the premise behind the ACA in controlling costs.” Pipes points out that the full impact of the ACA would not be realized until 2014 when the provisions were to be implemented.

With advances in medical technology, some of Dr. Gafanovich’s patients can live quality lives for longer. The challenge is that it is hard to predict which Medicare patient is going to die imminently as opposed to getting better without lots of expensive care.

Financial Interest

Why did Palin’s comment about death panels gain so much attention? Are there really people that are financially invested in the financial costs of lengthy and expensive end-of-life care? Analysts are asking these questions to attempt to get a better understanding of the issue.

It may be counter-intuitive, but hospitals don’t have an incentive to keep Medicare patients for any longer than is necessary. In 1984, in an effort to curb the tendency of hospitals to fill their most expensive beds, Medicare put in place 720 diagnosis-related groups (DRGs) which dictate what Medicare will pay for different conditions.

Although some believe that medical facilities could increase revenue by prolonging stays, the reality is that government reimbursement formulas limit what can be collected. The majority of health care providers fully understand the need to eliminate spending that is not the force behind measurable improvements in quality outcomes.

Some argue that pharmaceutical companies have a stake in a patients’ last months of life. The truth is pharmaceutical companies usually prefer to invest research dollars on blockbuster drugs that treat chronic conditions.

Some observers point out that the costs connected with end-of-life care are going to be high because people seek medical treatment when they are sick and not when they are young and healthy. Addressing unnecessary and unproductive medical interventions need to be a priority. The bottom line should really be an effort to provide the most comfortable experience as a patient approaches death.

The unique American attitude toward death manage is inflaming the debate. Some analysts say time and money could be better spend reforming medicines goals and focusing on preventative care. Some believe that this could create a higher quality of life without the same number of many medical interventions as well as pallative care at the end of life.

“We have a culture that has bought into the idea that medicine is meant to save your life,” Daniel Callahan, a research scholar at The Hastings Center, said. “But no matter how many medical treatments we get, it is never good enough because people will ultimately die. You can save them from one thing, but then death takes them another way. We are not in a winnable war against death.”