Paul Levy outlining some of the options dealing with the variability of end of life care:
As a person involved in policy-making in other arenas, I am left wondering what one would actually do with this information if you could “pass a law”. If you were in the government, would you act to apportion hospital and physician resources across the country? Highly doubtful. Would you change the method of reimbursement so that there would be a capitated payment for each type of chronic illness? I feels like that has been tried, and the public objected to someone — anyone — being the gatekeeper for how their care would be managed. Would you create a national standard on what services could be provided at the end of life, i.e., ration care? Politicians who have suggested that do not get elected. Could we adjust Medicare payments so that they provide ample payment for less acute care versus specialty care? That seems like a worthy goal for lots of reasons, but it is unclear to me how much it would do much on this front.
