The Cost of Dying

For those who missed it, here is a link to the segment on CBS’s 60 Minutes program on end of life care in hospitals, named The Cost of Dying. It aired this past Sunday.

This is a powerful and thought-provoking look at a milieu I know all too well from work experience. Our nation spends tremendous sums in caring for its citizens’ last few weeks and months of life, with many suffering in ICU’s with tubes in just about every orifice, unable to speak, often with arms tied down lest any of those blessed tubes become dislodged. And, as the segment correctly points out, the lion’s share of the financial burden is borne by Medicare. Which means, dear reader, since Medicare is a government-run health plan, the costs are paid by you and me, and even more so by our descendants when we run up ever more massive deficits.

Therefore, there are both humanitarian and fiduciary reasons to do what we can to improve the situation. That said, there are also right and wrong ways to do it.

We as humans are called upon to respect and support human life. Death is a part of life. We should acknowledge the fact and work in our healthcare organizations to provide more humane, dignified, and peaceful settings for people to live their final days. Hospice and palliative care services are cost-effective but woefully underutilized. The televised segment hits on the point that many doctors are uncomfortable about surrendering to the grim reaper, and in so doing they rack up monstrous expenses that improve nobody’s health. We should help them learn how to have those difficult conversations.

I am privileged to know intensivists who are very skilled in this area. I have seen how they work with families and hospital staff to, shall we say, improve the quality of death for patients. We would benefit from having more physicians with this skill set.

Ultimately, while the healthcare team can help them let go and accept the reality of irreversible illness, the patient and family must be in control of the decision. This is a fundamental human right, one we dare not abridge.

I was disturbed by some of the comments made by one of the physicians in this story. My hackles were raised when I heard him say, “At the present time, it’s their right” to have all lifesaving measures performed, referring to patients and those who speak for them. The implication, confirmed later, was that he advocates removing the capacity for making that decision from those who should be making it. Rather, he believes there should be nationally-determined standards for what modalities should and should not be used. He actually said that such panels will make it much easier to issue across-the-board denials of care. My jaw dropped. (Sarah Palin, call your office!)

I’m sorry, but government-sponsored rationing of care is not going to help our financial predicament, and it certainly will be devastating to countless patients and loved ones. We need ways to rein in costs while preserving patient choice and improving their quality of life, whether that remaining life be measured in days or decades. Government has never shown any aptitude for managing even the most delineated processes efficiently or effectively. Think Postal Service, Amtrak, Cash for Clunkers, this season’s flu vaccines, and, yes, Medicare – which has cost us and our children’s children many times what was ever estimated.

I have just started reading a fascinating book by Steven Spear, Chasing the Rabbit: How Market Leaders Outdistance the Competition and How Great Companies Can Catch Up and Win. A good portion of the book examines how top performing health systems manage to lead the pack. I will post a full review at a later time, but suffice it to say that the care innovations adopted by the “rabbits” profiled by Spear both improve quality of care and decrease cost – and, most notably for my current argument, not a single one of the innovations required or involved any sort of government intervention. As in all areas, in healthcare the free market can work, and it does when unrestrained by bureaucratic red tape and regulations.

Please view the 60 Minutes segment; it’s only 15 minutes long. Kindly comment on your impressions of the protagonists and any insights you are willing to share from your experiences – from either side of the bed rails.