End of Life Health Care is Our Biggest Health Care Problem, both Financially and Morally

These are horrible questions, but these questions must be asked. I do not claim to know the answers, but I do know that what we are doing now does not make sense.

The truth is that an extremely disproportionate percentage of health care costs are incurred in the last year of a person’s life. Over ¼ of Medicare expenditures (27%) are made on patients in their last year. ( http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm ) Roughly, $2000.00 to $3000.00 dollars are spent in a patient's last week of life.( http://archinte.ama-assn.org/cgi/content/short/169/5/480 ) As the baby boomers age, unpleasant choices are going to have to be made.

However, no one (understandably) wants to say, “Sorry, now that your best years are behind you and your utility to us has ended, you are more of a burden than you are worth, so if you wouldn’t mind too terribly, would you please die now?” “Broke your arm? Here is some morphine. These casts are getting expensive.”

Of course, the above is absurd, but it begs the question: Where do we draw the line? To what degree do we care for the health of the elderly before we decide it is not worth it? Is it moral to ask that question at all? Is it a sliding scale? Starting at the age of 70, is a person entitled to less care with each passing year? Do we draw the line according to condition, as in a broken finger is treated but a stroke is not? Do we draw the line according to prognosis, as in once the doctor decides that a person will not last a year, the morphine drip is wheeled in? If you thought insurance companies were tough on claims before, what happens when this Pandora’s Box is opened? Once it is considered reasonable for insurance companies to deny claims for terminal patients, what happens when the patients do not die as quickly as predicted? What if the doctor was wrong and the patient has 10 years left?

Our success with medical technology is ironically a part of the problem. It sounds horrible to ask, but in some twisted way, are we a little too good at keeping people alive?

This issue makes me upset, because my parents are in their mid-to-late 60’s.

We can not fix this problem by rationing care and deciding who gets what. This is not an issue that politicians can fix or bureaucrats can manage. The only way this problem will be alleviated is if our opinions about death and our opinions about our life cycle change.

In the meantime, I guess it all needs to come back to what is best for the patient.