Matthew Holt discusses President Ford’s expensive, last year of care:
My guess is that over the last 12 months of his life well in excess of $100,000 was spent on his health care. And that money probably extended his life by three months at most. Now for all we know they may have been the most wonderful three months ever for him and his family, but I’m inclined to think that if he’d died in the summer, his family would have been equally fine with it, and the nation wouldn’t have felt any differently about him. But the cost of extending life an extra year in this type of case is probably around $400,000.How can that possibly have been money worth spending? The answer is that it cannot have been.
I happen to agree with Matthew’s take. Graham takes an opposing view.
This topic was previously discussed on this blog a few months ago.
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- The consequences of doing everything in end-of-life-care
- IBD on health care reform: "Don’t believe a word of it"
- End of life care
- How much is your life worth?
- Are we wasting money on Alzheimer’s care?
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Why don’t we ask Dr. DeBakey, mentioned in another thread on this blog. According to the NY Times “The costs of Dr. DeBakey’s care easily exceeded $1 million”.
Half of the entire health care dollar pie is spent in the last 6 futile miserable months of peoples lives. That is fine if a person wants to pay for it, but medicare/medicaid shouldn’t pay for it.
If you are over 65 years old you CAN NOT pay for it under the current Medicare laws. Maybe the Medicare laws should be changed to allow private billing between physicians/hospitals and patients.
For the most part you don’t think about it when you are diagnosed with something that could be terminal. You go in for the test and the doctor comes out and says “you have this diagnosis, this is what we can do.” either to treat or to keep you comfortable. But you don’t stop to think, “Hmmm…I have metastastic breast cancer and the next treatment will last a year and cost over $100,000. Not only that you probably aren’t processing that the treatment at best is going to give you a few more extra months. If the doctors mentioned it, which they probably didn’t, you wouldn’t have heard it anyway. All you heard is this is “this is what we can do”. Pneumonia can be treated, should there be an age limit where treatment is no longer offered? And arterior sclerosis? Should there be a cut off age where the treatment isn’t offered? What age should it be where you are just left to die? And isn’t pallitive care expensive in itself? Are you saying that the aged and infirmed would be better off to go outside the tribal village to die so the young can take their place? At what age should compassion be replaced with callousness?
With the benefit of hindsight, it is easy to observe that a fair chunk of change is spent on the last x months of life.
This information is almost completely useless from a theraputic or policy standpoint.
Until there is a reasonable means by which the final x months of life can be discerned prospectively, then this discussion is worthless. Someone interested in saving billions could do the analysis: 1) analyze retrospectively the risk factors associated with being in the last x months of life. 2) then prospectively test the model by taking data on a real cohort and guessing whether they have more or less than x months to live. 3) publish the results. The reason we havn’t seen anything published like this is probably because the results have been dismal. Until we can identify futile care prospectively, we just have to keep plugging away just as was done for Jerry Ford.
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