[hrminer92]

Did you watch the clip? Expending huge amounts of resources in the face of certain death, with little hope of any improvement in quality of life. It's like he said....people think there's nothing worse than dying. That's not the case. There is living braindead for 10 years and then dying. Of course, there are some people that start early.

no. I don't have the luxury of watching TV at work.

[Toby]

most disturbing thread name I can remember.

That was the point, I'm sure. The real question is where we, as a society, place our spending priorities. Realistically, we can't afford to cover any treatment or coverage for any condition without a large degree of control over one side of the equation or the other. That's why I generally advocate discussing outcomes or penalties before proposing government action. IOW, if you want a single payer system, discuss what will be covered by that system. You can then make an informed decision on what it will cost and how it will be paid for. Or, if you want to criminalize a behavior, discuss how you will punish it first to determine whether the 'punishment will fit the crime'. Our current system tends to over-moralize first, and then worry about the mechanics later. That's how we wind up in debt to our children's children, or the Chinese.

[davidra]

I read an article not too long ago about this, from a slightly different agngle. They were talking about the availablility and use of hospice services. Hospice, under normal circumstances is something that is available to patients who are certifiably terminal (generally within 6 months) and is available to people who forego all other life saving measures. There were studies that made hospice (counseling, support, palliative care, etc.) available to patients with a one-year window, instead of 6 months, and they did not have to forego other measures. People who took advantage of the hospice services were able to discuss, with the hospice worker and with the family, issues like how do you want to die, what measures do you want taken, etc. They found that these people tended to use less, not more (usually futile) life extending services, even though they were available, and were more comfortable with their decisions and their situations. By the way, saving money, and not "pulling the plug." There was a one-liner at the end of the story last night that said in the health care bill, funding for hospice services was cut. This is not a death panel. This is not getting grandma out of the way. This is facing death realistically, with dignity and maturity, and not being forced (in some situations) to be plugged in to every orifice against your will.

I thought the story last night missed out on an important opportunity to reframe the discussion from "let's save money," to "how do I die with grace and dignity." I hope they cover this story again in light of this information.

There is no question that hospice can help....when it is actually used. In the month of June, I saw a patient who was on home hospice admitted twice to the hospital because his spouse had to work. Hospice sounds like a great idea, and it is, except that when push comes to shove, many families find that they really can't deal with their relative dying at home; it's just too painful. They panic.

Allow me to personalize. My mother died in November at age 94. She had significant dementia the last few years of her life, and had 24 hour home care. I moved her 600 miiles so she could be where my family was. We had DNR information all over her condo. On counters, stuck to the wall in the kitchen, by the front door....because I was afraid the caretaker would call 911 and they would try and resuscitate her. I was not about to have her in an ICU on a respirator. It so happened she arrested on a holiday, and I was at a store around the corner. I got there within minutes of the time she stopped breathing. I checked her pulse, did a few compressions, and determined that she was dead. Her caretaker had called 911 as I had instructed her to do, and the EMT's got there within minutes after I did. They came through the apartment, never looked at any of the documents, and were all ready to resuscitate her until I stopped them. The system and our culture of heroic medicine are biased against death with dignity. Nobody WANTS their parents to die...but they are going to, and in many cases, insisting that "everything possible be done" is just not right, no matter what the family thinks. I suppose that makes me paternalistic, or an ogre, or whatever descriptor you want to use, but every doctor and other provider knows that I am right. Not that I would EVER remove that decision making from the family....but that doesn't mean I wouldn't do everything in my power to educate them about the pros and cons of persistant vegetative states.

Patients that go to residential hospice are very likely to actually stick to the hospice program. Patients with home hospice, which are many more in number, tend to fail and get readmitted. But the major problem is that patients and families don't want to accept the fact that they have less than 6 months to live, which is the criterion in most places for hospice care. Until people can deal with realities, we'll continue to have this problem.

[Daisys Mom]

"Until people can deal with realities..." Yes. My point exactly. I'm so sorry for the loss of your mother. But I think we agree, the conversation must be started, and we have to stop pretending we and our loved ones are never going to die. I know these are difficult conversations to have (I had a hard time just talking about wills with my husband), but otherwise we bury our heads in the sand, and end up making hugely important and difficult decisions in a time of chaos and emotion. What kind of decisions come out of that?

I don't know. But I'm glad you started the conversation, and maybe got some people thinking about something they might not have have thought about.

Peace.

[clemgrad85]

Waste in health care? I had back surgery about 4 weeks ago, and a week before surgery I had to go get a back brace....I was told the hospital required me to have a back brace before I left the hospital. When they were "fitting" me for the brace (fitting was a ridiculous term, they showed me how to put it on) I asked how much this brace was going to cost and when the little assistant looked at me, I knew it would be ridiculous but was not expecting her to say $1000! When I expressed shock at this, you know what her response was? "Oh, don't worry, we have already had this approved by your insurance company." I told her that was not the issue, but rather the cost. Well, I got my EOB statement last week and the billed cost was $1500 but after the discount, it was brought down to $804.51. They also charged me $200 for the fitting, of which the insurance company didn't pay anything for (which I don't blame them, as it was 5 minutes of showing me how to put the brace around me and tighten it, I will be fighting this charge). I showed this brace to a woman who works at a PT office and she said I could have gotten a similar brace for $200 - $250.

Obama's health care plan will do nothing....NOTHING...to reduce this fraud. In fact, I believe obama health care plans on putting an additional tax on durable medical equipment which will simply be passed along to the consumer. This is why our health premiums are so high.....physicians who are greedy and only care about making money. Now....I personally am not opposed to anyone making money....but....I do get annoyed when some physicians blame the insurance companies for rising health care costs or playing hard ball on negotiated rates when we need physicians to stop charging these ridiculous rates.

[hrminer92]

I had an uncle that was supposed to have a heart operation, but he died at home before the date he was scheduled to go in. My aunt was livid when she received an invoice that the hospital had sent the Medicare claims processor. The hospital charged for a hospital stay he never made and an operation he never received. Even though she made lots of phone calls and sent in a copy of the death certificate that showed he died before the date of the operation on the invoice, the hospital still got paid.

[groovy]

If you don't want "someone like him" counseling your own family, then you will contribute to the problem. He said, and he meant, that whatever the patient decided they would do, and they did.

As you know, when it comes to health care, as with most things the average person doesn't understand, most people just want to be told what would be the best thing--by an expert they trust. I wouldn't really trust a person who seems so biased towards a certain outcome.

It doesn't take place in other countries to this extent, and it will bankrupt us most certainly if something isn't done. And you can rail all you want about Obamacare, or national health plans, or a single payor plan...that makes no difference. All these people will be in the hospital,insurance or not, and you will be paying for their terminal care one way or another.

One point brought out in the video was that there's no incentive to reduce cost because patients don't actually pay for their treatment. And the expense of that "perverse" system is compounded in terminal cases. I'm guessing you don't agree with that assessment?

[BARYE]

I've watched that piece twice now --

Very frustrating to attempt to discuss something like this rationally, when its so easy to exploit for demagogic advantage, so easy to scream death panels, to scream unplugging grandma, etc.

All that waste for the final futile agonizing end of life -- yet the other side would exploit people's fears in a heartbeat, its been one of their favorite tools to get political power

[groovy]

I've watched that piece twice now --

Very frustrating to attempt to discuss something like this rationally, when its so easy to exploit for demagogic advantage, so easy to scream death panels, to scream unplugging grandma, etc.

All that waste for the final futile agonizing end of life -- yet the other side would exploit people's fears in a heartbeat, its been one of their favorite tools to get political power

Don't you think the problem lies in the inability to predict with 100% certainty when "end of life" is? Would you go through extraordinary measures for an extra 10 years? Five years? One year?

[BARYE]

Don't you think the problem lies in the inability to predict with 100% certainty when "end of life" is? Would you go through extraordinary measures for an extra 10 years? Five years? One year?

If you are a 40 year old with cancer, a bad heart, a lame knee -- yes I want you to get care that can extend your life, improve the quality of your life.

I have a hunch that a 93 yr old human will not get a meaningful benefit from having a defibrillator installed whilst they're getting end of life care for terminal cancer.

ECUs are immensely expensive -- yet many 93 yr old humans spend their last days there. An enormous part of public health resources go just for palliative end of life craziness.

Similarly hospitals devout a crazy amount of money to "save" very sick, very premature babies -- babies doomed to short lives of poor quality.

If government resources are not unlimited, health expenditure ought be targeted toward those who can most receive benefit.

Heroic, cost be damned efforts ought not be lavished on the very very old -- or the very very young.

[Micael]

Yet, you never see Canadians complaining.

..... BAH-HAHAHAHAAAA!!!!

[Workerb33]

You may not see Canadians complaining about health care. But they certainly complain about how high their taxes are...

[Micael]

If you don't want "someone like him" counseling your own family, then you will contribute to the problem. He said, and he meant, that whatever the patient decided they would do, and they did. But he knew the man was not going to survive. There are some things that are indisputable...except for miracles. And if you want to spend billions of dollars in hoping for miracles when they're not going to happen, then you are adding to the problem. As was stated there needs to be an honest open discussion about our cultural addiction to heroic medicine, to attempting to save someone's life in the face of assured death. It doesn't take place in other countries to this extent, and it will bankrupt us most certainly if something isn't done. And you can rail all you want about Obamacare, or national health plans, or a single payor plan...that makes no difference. All these people will be in the hospital,insurance or not, and you will be paying for their terminal care one way or another.

This argument boils down to who decides the how and when someone else should die. The family - the doctor - the insurance company - or the government. It seems to me that you believe that it should be the government, based on the fantasy that the goverment will save money and resources. Does that about sum it up?

[psm9]

For me, it's not about saving money and resources. Health care should not be a for-profit system. Health coverage should be a universal right in this country and not a privilege. For having, supposedly, the "best" health care system, we rank low in rates of prematurity, neonatal death, maternal death, vaccination, etc...

One of the commenters above mentioned the cost of the care of the very-old or very-young. Keep in mind that those limits have moved over the years. 50 years ago, a 34-week premature infant was on the fringe of viability and would die (normal is 40 weeks). Now, even 28-30 weekers nearly always live with minimal complications. The new fringe is 23-24 weeks. Who knows in 10 years? The same for elder care. What was "too old to save" 50 years ago is normal care nowadays (and with good outcomes). We spend a ton on money on those folks at the fringes (old and young), but that experience moves the fringes outwards over time and saves lives that would be lost in the past.

[Micael]

For me, it's not about saving money and resources. Health care should not be a for-profit system. Health coverage should be a universal right in this country and not a privilege. For having, supposedly, the "best" health care system, we rank low in rates of prematurity, neonatal death, maternal death, vaccination, etc...

One of the commenters above mentioned the cost of the care of the very-old or very-young. Keep in mind that those limits have moved over the years. 50 years ago, a 34-week premature infant was on the fringe of viability and would die (normal is 40 weeks). Now, even 28-30 weekers nearly always live with minimal complications. The new fringe is 23-24 weeks. Who knows in 10 years? The same for elder care. What was "too old to save" 50 years ago is normal care nowadays (and with good outcomes). We spend a ton on money on those folks at the fringes (old and young), but that experience moves the fringes outwards over time and saves lives that would be lost in the past.

Interesting. On one hand you extoll the advances that have saved countless premies, and on the other, you wish to destroy the very system that made those advances - a system supported by those "evil profits". It's our for-profit companies that funded the research that discovered those improved methods, not the government teet (i.e., our taxes).

The unescapable truth is that healthcare costs money. There is no "free" system. All systems have thier quirks, but so far the free market seems to drive the advances. Look to the stagnation of the USSR system to see the antithesis.

[psm9]

Yeah. I'm complicated. On one hand, we could vaccinate thousands of children from the money spent on one liver transplant. On the other, liver transplants were crazy experimental 20 years ago and are now much more common and standardized. The "ridiculous" expenses of the past now lead to years and years of productive life for people in the prime of their lives. No easy answers...

I do think that people need to be able to make their own choices to accept or refuse extreme care.

[Workerb33]

Yeah. I'm complicated. On one hand, we could vaccinate thousands of children from the money spent on one liver transplant. On the other, liver transplants were crazy experimental 20 years ago and are now much more common and standardized. The "ridiculous" expenses of the past now lead to years and years of productive life for people in the prime of their lives. No easy answers...

I do think that people need to be able to make their own choices to accept or refuse extreme care.

hmmm, liver transplant... know anyone who had one of those lately?

[psm9]

yes, but I'm a doctor, so I may not be a representative sample.

Take out liver and use kidney or bone marrow. Both are much more common and can have great outcomes nowadays.

[Workerb33]

yes, but I'm a doctor, so I may not be a representative sample.

Take out liver and use kidney or bone marrow. Both are much more common and can have great outcomes nowadays.

um, that was a Steve Jobs joke...

[switchedgear]

Well if it wasn't for us americans a lot of canadians would be speaking german right now!;-)

Illegal Americans loves ours! (Canadian)


That's right, our tax payer money goes to people who live in first world country, have jobs, make money, pay taxes, but can't afford health care, or lost their jobs for a while.

Yet, you never see Canadians complaining. Whenever the topic of health care comes up we simply encourage you to get a universal service, not because we're sick and tired of your hypocritical people taking advantage of ours, but because we think every american has the right to health care.