How to Save Medicare? Die Sooner (forbid end of life "unproductive care")

[papau]

http://www.nytimes.com/2005/02/27/business/yourmoney/27view.html

How to Save Medicare? Die Sooner
By DANIEL ALTMAN

Published: February 27, 2005


HOUGH Social Security's fiscal direction has taken center stage in Washington of late, Medicare's future financing problems are likely to be much worse. President Bush has asserted that the Medicare Modernization Act, which he signed in 2003, would solve some of those problems - "the logic is irrefutable," he said two months ago. Yet the Congressional Budget Office expects the law to create just $28 billion in savings during the decade after its passage, while its prescription drug benefit will add more than $400 billion in costs.

So, how can Medicare's ballooning costs be contained? One idea is to let people die earlier.

For the last few decades, the share of Medicare costs incurred by patients in their last year of life has stayed at about 28 percent, said Dr. Gail R. Wilensky, a senior fellow at Project HOPE who previously ran Medicare and Medicaid. Thus end-of-life care hasn't contributed unduly of late to Medicare's problems. But that doesn't mean it shouldn't be part of the solution. "If you take the assumption that you want to go where the money is, it's a reasonable place to look," Dr. Wilensky said.

End-of-life care may also be a useful focus because, in some cases, efforts to prolong life may end up only prolonging suffering. In such cases, reducing pain may be a better use of resources than heroic attempts to save lives.

The question becomes, how can you identify end-of-life care, especially the kind that's likely to be of little value? "It's very difficult to predict exactly when a given individual is going to die, in most cases," said David O. Meltzer, an associate professor of medicine at the University of Chicago who also teaches economics. "But there's no question that there are many markers we have of someone who is approaching the end of life."
<snip>

[Jim Sagle]

1. "an associate professor of medicine at the University of Chicago who...

also teaches economics."

Ahh yess...the Chicago school of economics: "Kill those geezers, they're nothing but useless tax eaters." :puke:

[Spinzonner]

2. Don't be too quick to criticize

Think of how much pain might have been avoided had Milton Friedman died young.

(Yes, I know he's still alive)

[jwirr]

5. Didn't Stauss the repug guru also teach at the University of

Chicago?

[98geoduck]

3. The lack of preventative health care may be a cure for what ails the rich.

Irony intended

[Malva Zebrina]

4. pro-life--except when you get old

In this illustration, the Nazis demonstrated that the daily cost to the state of maintaining one chronically ill person (5.5 marks) could be better spent supporting an entire healthy German family.

[jwirr]

6. That was also the position

of the eugenics movement in the early 1900s.

[Warpy]

7. The problem with that is that you never know

which elderly folks will get that broken hip fixed or that pneumonia treated and go home and enjoy life for another five years and which will experience a cascade of disasters and die in the hospital after sticking Medicare for hundreds of thousands of dollars. You can't tell by looking at them, by their lab work, or their bank accounts. You don't know what's going to happen until it does.

If Mr. Dr. Economist Meltzer has figured out how to tell the difference, he needs to write a book on the subject and enlighten the rest of us.

However, it would be nice if hospitals had ethics committees with the power to overrule families when the catastrophic physical failures have already occurred and the family wants extraordinary means used to prolong death.