The cost of keeping the terminally ill alive

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.

And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and is one reason our healthcare system is in trouble.

Modern medicine has become so good at keeping the terminally ill alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily.  The way we set up the system right now, primary care physicians don’t have time to spend an hour with you, see how you respond, if they wanted to adjust your medication. So, the easiest thing for everybody up the stream is to admit you to the hospital. And once someone is admitted to the hospital they’re likely to be seen by a dozen or more specialists who will conduct all kinds of tests, whether they’re absolutely essential or not.

According to Dartmouth’s Dr. Elliot Fisher,

Supply drives its own demand. If you’re running a hospital, you have to keep that hospital full of paying patients. In order to, you know, to meet your payroll. In order to pay off your bonds.When it comes to expensive, hi-tech treatments with some potential to extend life, there are few restrictions.  By law, Medicare cannot reject any treatment based upon cost.

It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

The real problem is that many of the patients that are being treated aggressively, if you ask them, they would prefer less aggressive care. They would prefer to be cared for at home. They’d prefer to go to hospice. If they were given a choice. But we don’t adequately give them a choice.

Should the FDA approve drugs that extend life a few months at a really high cost to the government?  That is an explosive issue to tackle.  Most of us want to die with dignity and peacefully and research that I conducted with cancer patients last year indicated that a lot of them do not want to go through extensive treatments that have horrible side effects if there is no hope of a better quality of life.  Eventually we are going to have to decide if it’s better to keep people alive, connected to machines at a huge cost, with no hope of recovery or to let move onto as nature had intended.  Sometimes I wonder, do we keep people alive and in misery for ourselves or them?

Richard Meyer is Executive Director/Principal at Online Strategic Solutions and blogs at World of DTC

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  • Stacy

    The same can be said of children born extremely premature (before 24 weeks).

  • tpetrusick

    I agree with Stacy above.
    On the elderly with high end of life cost I had this with my mother.Admitted with pneumonia and atrial fib (84 yr old) cardiac ICU and step down d/c home and a month later pneumonia again. Cardiac icu and d/c to nursing home for convalesence. Then assisted living until stroke, seemed to stabilize then another stroke. At this point regular hospital room until death. I have thought about the cost which was great but could have been a lot greater. Our experience seems to be the norm from my observation but I think spending less or less care would have been inhumane, but still it was a very expensive five months. If you look at what we spend on a young person trying to salvage a life we either need to be wiser or get this kind of care for a lot less money

  • rezmed09

    There are two powerful words that will end this debate until we go broke: “Death Panels”. This explosive and erroneous phrase got people removed from Congress, made celebrities out of average people and prevented all further rational discourse.

    • Alice

      Umm….fact check…go to google and put in the name of Paul Krugman, the award winning author economist…liberal…on ABC news he said we need death panels and a VAT to pay for healthcare. Go to his NY Times blog and see the outrage….over the VAT. Sigh! These are legislated, Orwellian appointed panels that will have the power to overrule the family. Read the wording on the goals pf the appointed panels…save money… Because the last six months of a person’s life are expensive… complain…..the appointed panel decides you are too costly to keep alive….yep…a death panel. I am not a supporter of Sarah Palin…but she was right…the media has their own death of reputation panel going on and if we take what they say and do not research we end up believing fallacies. Death panels could be a reality. The media did not read the legislation and either did those who voted on it.

      The repercussions of placing a price on life will hurt babies…go to the UK socialized medicine stories in the British press. Gotta watch what you support. Because it could be your own family snuffed out…why….because keeping them alive will be a burden on the system.

      Think an idea through and really consider where an ideology can lead…I know the foundation of this thought….seemed so reasonable….yet…it is deadly. Sigh!

      • rezmed09

        You validate my point.

        In the end we will spend whatever resources we have on anybody no matter how futile. The determining factor will only be what people want – no matter how expensive , and no matter how ineffective. And don’t forget, much of what people think of medicine comes from drug ads and TV Shows where most people are saved and doctors are so often wrong. For now we will not make any tough decisions and, in America, everyone gets what they want – no matter how expensive.

  • Danimal

    As a non-doc I’m curious: in what percentage of those cases do you think it was obvious that they were in the last 2 months of life? I’ve seen healthy, non-demented old people go in to the hospital after, say, falling — and then rapidly going downhill and dying (or turning into a perma-Gomer).

    If I were to go to the hospital now, with the knowledge that I had only a few months, I’d definitely pursue hospice rather than invasive treatment. However, if I didn’t know that — then went downhill — I might not understand what was going on, and keep fighting.

    So can some of it be communication and perception? Or is it really patients saying, “Yeah, I know Dad is breathing broccoli, but do everything you can to keep him going”? And, if the latter is true, why is that not elder abuse?

  • L.

    This is a sincere question – If the care were more reasonably allocated (that is withdrawn from those who are actively dying, and likely to do so within a short time no matter what therapies are applied) what happens to all the people who are supported financially by all this unnecessary care – from the big earners – the doctors, the hospital administrators to the custodial staff and cafeteria workers? Someone’s going to be earning less. Some (maybe many) people will lose their jobs – and it won’t just be the cafeteria workers.

    All those big expensive hospitals have been built (and continue to be built), the equipment purchased, the drugs developed. I imagine the lobby against any rationing of care will be loudest from those most likely to be hurt financially from such actions. But, it will be couched in terms of “death panels” and other emotional language designed to motivate the great unwashed to decry the horror of it all. Make no mistake – the money behind such cries will be from those who stand to lose the most revenue and profit – no matter the faces you see fronting such an outcry.

    It’s hard to imagine that doctors, other health professionals and hospital executives will really start educating patients about the futility of care when they all stand to lose so much revenue in doing so. There are a few voices in the wilderness talking about this – but let’s not pretend anyone with any authority or ability to change this on a macro level would do so. Yeah – I’m talking to you. I mean – we have a U.S. senator whose entire fortune is tied into this very model. The wagons have circled.

    • Alice

      Doctors want immunity from any legal actions for their own acts in their supposed compassionate care. Yes, jobs will be lost…but when price is the factor…it means more jobs from future innovations and ideas die with it…that means innovative ideas that could save a life will not be a reality and more people will die. We see this with the difficulties of research. Too rushed to get into that. Regulation and more mandates are rarely the answer to our ills.

      • L.

        I’m sorry, I don’t understand you. Are you saying that it’s necessary to have unnecessary care in order to fund research? And, I don’t understand how the immunity for doctors factors into this particular topic.

        The question I was asking is if let’s say 50% of this end-of-life care were to be stopped – what happens to the individuals benefiting from the revenue that care generated? Are there enough “worthy” patients to make up for the loss of revenue from the “unworthy?” That $55 billion went to support a lot of people.

        • Alice

          I agree a whole industry was created for end-of-life care. I support hospice care and all the nice innovations they use to care for someone who is dying. One needs to study the UK model to understand where the mindset of death panels will logically take us. People think along the lines of Krugman who did do some backpedaling……but economically he is right..we need a VAT to generate money and death panels to kill those expensive people who are already at death’s door. He just, basically, feels…….hey if they are dying why mess around with costly treatment. From a purely economic standpoint he is right….but overruling a family with a panel (appointed yet……I don’t care if one is a hospice worker and one a doctor and one a puppet master…..ugh! the deck can be stacked by the appointee).

          Do some google searches about the UK. The stories are mind bending and this attitude does spill over to babies.

          There is a bioethicist Wesley Smith who wrote some good articles on this. I quote him on the POLST thread. I agree with him that morally we don’t want to go there. Also, National Review has a very good article on the death panels and the feedback was a bit shocking.

          • Paul Watson

            ‘One needs to study the UK model to understand where the mindset of death panels will logically take us. ‘

            What ‘model’? Are you talking about hospices? The hospice movement was pioneered in the UK. It’s been widely adopted around the world, including in the US.

        • Killroy71

          Unquestionably, there would have to be a shift in the health care sector if the Dartmouth Atlas’s estimate of one third ($700 billion) in needless treatment was actually diverted. As you point out, one sector’s waste is another sector’s revenue.

          The health care sector supports many well-paying jobs. How many jobs in new sectors could be supported if we could reallocate that $700 billion? Not to mention, how would quality of live improve if people are not overtreated or subjected to medical errors simply by entering the “system” ?

  • Miranda

    It is sad that so few patients are able to speak for themselves. Yesterday, had a beautiful conversation with a 91 y/o woman who just didn’t know how to tell her family that she would rather just go home. She knew she was dying, she just didn’t know how to tell everyone else.

    The problem is America is not that care is withdrawn because of cost, the problem is that it is NOT withdrawn because doctors benefit from all of that extra treatment. I hope when I’m 91 I’ll have someone who will speak for me when I’m too scared to speak for myself.

  • Jack

    I am sorry that some of you actually feel that doctors WANT patients to suffer during the last two months of their lives. It’s most certainly NOT true. There are countless number of times that the FAMILY INSIST on trying ADDITIONAL measures even though it’s futile. Patients go to 2nd, 3rd and 4th opinions and get treatment from somewhere from someone.

    I’ve seen family who REFUSE to make ANY decisions because they DON’T want that responsibility.
    There has been times that I just said NO. That’s not reasonable and you will need to find another doctor if you want something else done.

    What bothers me here is that people just feel like doctors need to do everything including making all the decisions for their families. We often lay out the options and try to guide you but YOU as the PATIENT had the ultimate decision.

    You do realize that patient also has the right NOT TO GO TO THE HOSPITAL or call 911.

    • Melinda

      I agree. I use to work in a critical care dept. and saw how families insist that their love ones be kept alive no matter what. They were feeling their own guilt from our beliefs about death and not giving up. Had a lady just the other day tell me her friend “gave up” her “fight” with cancer. This cancer patient has felt miserable for a long time and the cancer has spread. If I’m ever in the position like this patient, I will slug the people who tell me that I am “giving up the fight”. I guess humans feel it is politically incorrect to say, “it’s OK, we will support your decision and we will be their for you.”

  • Primary Care Internist

    i’m with jack- mostly it’s PATIENTS’ and FAMILIES’ unrealistic expectations, and their lack of skin in the game, ie. doesn’t cost them anything directly (or maybe a small copay).

    I don’t know any doctors who want to put the elderly thru the endless charade of hospital / “rehab” / nursing home / maybe a stint with bogus homecare e.g. VNS / back to hospital / repeat cycle ad nauseum until death.

    But I’ve had even highly educated patients and families (even other doctors) who refuse to give up any last shred of hope even when all involved know there isn’t any.

    And as for the “research that I conducted with cancer patients last year indicated that a lot of them do not want to go through extensive treatments that have horrible side effects …” when it’s not a hypothetical situation in a research setting, when it’s really cancer facing someone, then their decision will often be different. Here’s an analogy for all you readers: For all of you who agree with not wanting treatment with horrible side effects when there’s no hope etc., how many of you have actually completed any kind of advanced directive on paper? or discussed it seriously with your family??? yup, thought so.

  • weakanddizzy

    Agree with Jack and Primary Care Internist. I can’t tell you how many times I and my colleagues have had this conversation with elderly dying patients. Frequently the patient is demented and can’t participate in the discussion. Usually it is the spouse or children who can’t bear to let go and are hoping for a miracle. In spite of recommendations for comfort care, hospice and no further hospitalization of their loved one they continue to demand aggressive ( even to the extent of requests for ventilators, feeding tubes, etc.) care which the healthcare workers know is futile. It is this cohort of patients/families that are “breaking the bank” so to speak. And before you blame the physicians for continuing this futile care realize that many of these families hold the specter of a lawyer over your head. This is defensive medicine that our legal brethren fail to acknowledge. This futile medicine is costly and will continue until our society acknowledges the inevitability of death and the politicians grant the physicians some protection from refusing to participate in this expensive end of life, futile care.

  • SarahW

    Really, we ought to have some sort of panel to decide these things.

    • Molly Ciliberti, RN

      We need to encourage people to decide now while they are of sound mind, how do they want to die, do they want to fight till the bitter end or get supportive care so they can die in peace?

  • doc99

    “… They may as well get on with it and decrease the surplus population.”

    • Alice

      Umm….let’s see….what occupation should we decrease after we get the public to realize that really old people are sick and worthless? Hmmm…..lawyers? Doctors? Politicians? Insurers? Oh that’s right…we are already doing this with inconvenient babies…yeah…by the millions….a thought taken to it’s logical end can often visit our own home. Ideas have consequences.

      • L.

        This is a quote from Dickens’ “A Christmas Carol,” and is actually in support of what I assume your view is – that all life is sacred and we should not, as a society, do anything to encourage cutting short that life in any way. The poster meant to be ironic, I believe.

        • Alice

          That’s a great quote from Dickens. Thank you!

          Francis Schaeffer the great theologian of the last century understood where eugenics and devaluing of life would go when he said:
          ‘If the fetus gets in the way, ditch it. If the old person gets in the way, ditch it. If you get in the way. . .’”

  • DrB

    I am a Hospice doc as well as solo Family Med. The “legislation” of this topic is pure fodder for both sides of the debate. Making it a legal decision when to stop providing care is madness, so I say leave it out altogether. My advice is to educate, educate, educate, and re-educate. Make it the patient’s decision, and let families know they are doing a wise and noble thing, not “giving up.” A study release in NEJM last August showed that people live “longer” on Hospice. So docs need to share and emphasize this bit of advice: “want to live longer and better? Sign up for Hospice.” If it does not make sense to them in the first visit, gently repeat as needed.

  • Jack

    What I often see and hear remain true.

    “Let’s cut government spending….blah..blah..blah….but wait….don’t cut services that affects ME.”

    Me first society. I can do no wrong. It’s all YOUR fault.

    No problems will be solves until we realize that we are ALL part of the problem and solution. Until enough of us do and the tipping point is reached, nothing will be solved.

  • alice

    Um..on cellphone…I will be quick…drb…is not keeping up on legislation…those who not know should learn how to educate themselves before spreading misinformation…use the search button on this site and type in POLST and see what legislation does say..and there is so much more… drB. …thanks for segue because it jogged my memory to share this.

  • alice

    Jack there are several issues here…economics…and morals….that is why putting a price tag under the guise of altruism is wrong. The repercussions are too much. Haven’t we killed enough healthy babies, and now Down’s Syndrome babies are nearly extinct. We can justify our actions. Play kill the messenger…but abortion opened the door on devaluing of human life. That is why we are having this discusssion?

  • Finn

    I’m a cancer survivor who paid attention to the Terri Schiavo fiasco and therefore have an advance directive. So does my elderly (but so far healthy) mother. Knowing her wishes will keep me & my siblings from having our sense overcome by our emotions when she is dying. This is exactly what the language that Sarah Palin mischaracterized as “death panels” was intended to do: Allow Medicare recipients to have an appointment with their doctors to discuss what types of measures they would and would not want to have taken if their health were failing and they weren’t able to make their wishes known at the time.

    But a salacious lie is always more exciting than the truth, isn’t it?

    • Melinda

      I totally agree. Thank you for bringing this subject up. My mother had not taken care of this part and I took her down to a friend of mine who is a lawyer and we took care of any end of life decisions. Some folks don’t even want to think about this. I have secretly wished my dogs would be in charge of my own end of life decisions to be fulfilled because I know they would “do the right thing”.
      I don’t trust my human family to let me go when it’s time.

  • Alice

    Now, now Finn……….do your research…because mislabeling the truth a lie is far more than salacious. Death panels may not be an “official” word, but it doesn’t change their existence. They will decide if one lives or dies. But let’s keep it all nice and pretty and call them “appointed panels” whose existence is a sentence of life or death over a families objections.

    Paul…I am rushed. If you search Kevin’s site for “death panels” you will find the UK stories I share from UK newspapers. One from a mom whose baby could have been saved, but money and lack of the innovative equipment we have here meant it had to die. Loads and loads of stories to. Not hard to find.

    I guess if all one does is watch MSNBC, or their other affiliates you would tend to believe I am off. I don’t subscribe to cable. I read magazines with liberal bents like Newsweek, TIME, and US News (they are going under soon), then I really like The Atlantic and New Republic. I need time because I believe the New Republic did a good blog and the writer was flamed pretty badly. People don’t mind death panels….until it’s their child….they just don’t want more taxes. Sacrificing granny doesn’t seem to bug most of them.

    • Paul Watson

      Alice, the data I see from the US show we have worse access to healthcare, higher death rates from medical errors, high unnecessary use of medical intervention, overall higher mortality and of course much higher costs. when compared with European countries. In fact, it seems that at end of life, data show that our medical intervening can actually shorten life and often makes people less comfortable compared with care in hospice or at home. I think you could usefully look at how and why the Brits founded the hospice movement before throwing around this silly death panel nonsense.

      • Alice

        Paul….I post a lot on this board and I really don’t know who has read previous posts and who hasn’t. So, I apologize to those I am boring to death (no pun intended…..gosh…glad there are no pun panels! Sorry, I picked up my sardonic humor when living in Britain. The care truly terrifies me and my husband who could fly back tomorrow and get free healthcare for him or our children. He still has his national ID. I doubt I could get care, but bugger all that…I don’t want it).

        Anyhoo………I will get you the stats, but American Spectator also had an article on death panels and I believe National Review. It’s not a figment of my imagination…quite frankly….the repercussions are horrifying when seen to the end. I won’t bore anyone who is reading because they can easily do a search of this site and find the “death panel” discussions, but the British stats are harder to come by here (not online, they are easy to find there).

        You probably know the Brits are protesting…and in their typical fashion quite brashly about the cuts. That means an already bad system will become worse…but it’s the side of socialism. We want, we want, we want………France is having the same thing…’s like trying to get a binky off a four year old.

        American Spectator….and be sure to check out Reason Magazine’s article on the biggest lie of the administration. It’s straighforward and interesting reading. I subscribe, but I think you can find it on the front page. If not, just ask me and I will send it to you.
        Don Berwick’s Death Panel?
        By Robert M. Goldberg on 11.16.10 @ 6:08AM

        Are Medicare director Don Berwick and the Obama administration delaying or denying patients access to medical innovations? That’s a question the Senate’s Finance Committee should ask Berwick, who heads up the Center for Medicare and Medicaid Services (CMS), when he testifies November 17.

  • Alex

    I am an Obstetrics trainee with neonatal experience practicing in the UK. I think that the case which you are referring to is that of Jayden Capewell, a baby who was born at 21+5 weeks gestation. Generally in the UK we offer resuscitation at 23 weeks if the parents want it, and otherwise beyond 24 weeks. Ocassionally at tertiary centres intervention is offered beyond about 22+4.
    This baby would not have been resuscitated in the US (the Florida baby always quoted was offered intervention based on an incorrect assumption about gestation), and has nothing to do with the system of socialised medicine in the UK. The huge majority of babies at this gestation will die or survive with severe handicap at extreme cost, both emotional and financial.

  • Alice

    National Review article and feedback on the blog (which can cause one to be disappointed, demented, or delighted!:):

    Death panels

  • Alice

    Alex I think you are right, but disagree with you as far as care. Aren’t 4,000 babies a year born in hallways? Considering you are about 1/6th of the population here and your rate of infection is much higher, and if you have cancer your chances of survival are much better here……….I will stay right here (although, as I shared previously we could come back to the UK and get free care…no thanks! Cancer care leaves much to be desired there). for those interested this is a short, interesting article:

    This is just a tiny bit of what letting the government run out life and health care as well as the DMV is run.
    The famous lawyer, author Chuck Colson has a ton of documented stuff on his site:

    In the midst of the very heated debate going on about health care reform, one thing is becoming clearer and clearer—most Americans do not trust the government to make health care decisions for themselves or their families.

    You don’t have to look far to see that their mistrust is well founded. Check out the British press virtually any day online, and you will find horror story after horror story about what can happen when the power of life and death is handed over to a government bureaucracy.

    I’ve spoken before about Britain’s National Institute for Health and Clinical Excellence (and I’ve also pointed out the sinister irony of that organization’s acronym, NICE, which was the center of evil in C.S. Lewis’s famous novel That Hideous Strength). NICE and similar agencies are setting health-care guidelines for the British National Health Service that are leading directly to a devaluing of human life.

    Take the story of Bruce Hardy, who was denied the expensive cancer treatment his doctor wanted him to undergo. He was not even given the chance to pay for part of the treatment himself.

    Just this month, Rosemary Munkenbeck told the Daily Telegraph that doctors withdrew fluids and drugs from her father elderly father, Eric Troake, after he suffered a stroke. He appears to have been treated according to a National Health Service “pathway scheme” for dying patients—even though it was not clear that he was actually dying, and despite having said that he wanted to live to be 100 if he could.

    “[Doctors] say my sister and I are cruel and are trying to hold on to our father,” Munkenbeck said. “But this man has a right to life….He’s not suffering from a terminal illness, he just had a stroke. We just feel they decided from the beginning that he’s 95 so they’ve written him off.”

    And the Daily Mail recently carried the story of Sarah Capewell and her son, Jayden, who was left to die by doctors because he was born at 21 weeks and five days. Had he been born only two days later, Jayden would have been given medical assistance and might have survived. But British government guidelines for National Health Service hospitals state: “If gestational age is certain and less than [22 weeks] it would be considered in the best interests of the baby, and standard practice, for resuscitation not to be carried out.”

    Though Jayden, delivered by a midwife, was breathing on his own and moving his limbs, doctors refused to treat or even see him. Capewell says she said to one doctor, “You have got to help,” and he responded, “No, we don’t.”

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    Some lives may indeed be impossible to save. But what we have here is a government bureaucracy that has the power to determine—as a matter of policy—not to save lives that could be saved. In essence, determining whose life is worth the expense.

    The proper, biblical role of government is to protect the well-being of its citizens—to provide security and promote justice, not to usher them into the next world by denying them medical care.

    Do we need health care reform? Of course we do; I’ve said so before. But as Christians, we must not assent to giving unaccountable bureaucrats the power to determine the value of a human life—or to withhold medical care from those whose survival is somehow deemed outside the national interest.

  • Alice

    How the US stats are not compared in a proper scientific manner. They are “doctored”.

    We hear a lot about how wonderful it is that the Canadians or the British or the Swedes get free medical treatment because the government runs the system. But we don’t hear much about the quality of that medical care.

    We don’t hear about more than 4,000 expectant mothers who gave birth inside a hospital, but not in the maternity ward, in Britain in just one year. They had their babies in hallways, bathrooms and even elevators.

    British newspapers have for years carried stories about the neglect of patients under the National Health Service, of which this is just one. When nurses don’t get around to taking a pregnant woman to the maternity ward in time, the baby doesn’t wait.

    But the American media don’t tell you about such things when they are gushing over the wonders of “universal health care” that will “bring down the cost of medical care.”

    Instead, the media spin is that various countries with government-run medical systems have life expectancies that are as long as ours, or longer. That is very clever as media spin, if you don’t bother to stop and think about it.

    Author Sally Pipes did bother to stop and think about it in her book, “The Truth About ObamaCare.” She points out that medical care is just one of the factors in life expectancy.

    She cites a study by Professors Ohsfeldt and Schneider at the University of Iowa, which shows that, if you leave out people who are victims of homicide or who die in automobile accidents, Americans live longer than people in any other Western country.

    Doctors do not prevent homicides or car crashes. In the things that doctors can affect, such as the survival rates of cancer patients, the United States leads the world.

    Americans get the latest pharmaceutical drugs, sometimes years before those drugs are available to people in Britain or in other countries where the government runs the medical system. Why? Because the latest drugs cost more and it is cheaper to let people die.

    The media have often said that we have higher infant mortality rates than other countries with government medical care systems. But we count every baby that dies and other countries do not. If the media don’t tell you that, so much the better for ObamaCare.

    But is life and death something to play spin games about?

  • Alice

    Most Cancer Survival Rates in USA Better Than Europe and Canada

    This is from bioethicist Wesley Smith who has authored some books.

    Most Cancer Survival Rates in USA Better Than Europe and Canada
    Wesley J. Smith
    One of the excellent aspects of the current American health care system is that most people can get immediate help if they become very ill. Not true in places like Canada or the UK, where waiting lines for crucial imaging tests can range in the several months–months that for cancer patients can mean the difference between living and dying.

    I decided to do a little research on cancer survival rates, and it turns out USA is # 1. From the fact sheet put out in 07 from the National Center for Policy Analysis:

    According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology :

    American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women. [See Figure I.]
    American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.
    Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
    For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.
    These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent.

    But what about Canada, Wesley? Canada is the ideal of single payer health care:

    Canada’s system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O’Neill, former director of the Congressional Budget Office, and economist David O’Neill, found that overall cancer survival rates are higher in the United States than in Canada:

    For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
    For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

    Early diagnosis is the key, which gets us to the crucial screening issue:

    It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government.

    * In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.
    * The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.

    This is a very important aspect of the current debate. Reform is necessary to increase access of our uninsured to these very services. But destroying what works for the vast majority of Americans to accommodate the needs of the few–when that matter could be corrected with a far less draconian approach–must not be allowed to succeed.

    Share this post
    July 21st, 2009 | 6:04 pm
    Just wanted to say thank you so much for all these articles on the dangers of universal health care. Keep ‘em coming.

    Was wondering if you could have your web-masters put on a “share” button for your posts, so we can post them to places like Facebook. Thanks!!

    Bob Haiducek
    July 22nd, 2009 | 11:59 am
    Heather (July 21), the information in this article is extremely misleading. In the U.S. there are a lot of praises about surviving cancer. The other countries prevent the cancer from occurring in the first place. Take a look at this information about minimizing deaths due to preventable diseases among 19 countries:

    Regards, Bob the Health and Health Care Advocate

    • Diora

      Alice – 5-year survival rate is a not a unreliable metric in this case as it is subject to lead time bias and overdiagnosis. There is more screening in the US, so more cancer gets diagnosed. If a cancer is diagnosed at age 45 in the US and same cancer is diagnosed at age 58 in Europe, and both people die at 51, you’ll get a better survival rate in Europe – lead time bias. Some of these cancers would’ve never progressed if remained undetected, but they are really easy to cure => better survival rate.

      The only reliable metric is population-based mortality rates i.e. percentage of people in population who die from a specific cancer in Europe vs US.

      • Alice

        Diora …I have a daughter with cancer and the eight months it took to get the proper biopsy has created a spread that put her at level 3. ‘ll take early detection, and short waiting lists any day.

  • Paul Watson

    Alice, I’m not sure what point you’re trying to make here. We’re talking about decision making in end of life care, in the terminally ill. We’re not talking about medical error made in treating someone who is not terminally ill, but if you want to extend to that you need to realise that the US actually has higher medical error rates than other developed countries, and also performs poorly in other measures such as access to care and deaths from preventable causes. In fact, we come last behind Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom in ‘measures of health system performance in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives’ – see

    • Alice

      Paul the reason I gave those articles is because peripheral issues were raised that surround the main topic. I found the stats last night in a good source…but they do not agree with your owh and I hesitte to bog down the blog with more stuff.

      As I shared…if you had to actually experience care there and then here …well….since we are quoting old music…this time it would be The Monkey’s…..I’m A Believer!

  • Molly Ciliberti, RN

    We need a diagnosis “dying”. As a former ICU/CCU nurse the last place I want to die is in an intensive care unit. I prefer my kitchen or on the deck or under a tree. I don’t want tubes and machines keeping my body alive when I really am worn out and just want to go to sleep. Yes, I have all of my documents in order so please don’t call 911, just put on the Beatles and let me be in peace.

    • Alice

      Yes, I have all of my documents in order so please don’t call 911, just put on the Beatles and let me be in peace. [end quote]

      LOL. Maybe the Beatles, “HELP!” would work?

      I agree that paperwork is important..planning is vital as well as a complete education on the reality of expectations.

  • Alice

    I was reading today’s update from a site I like called Disruptive Women In Healthcare and here is just a snippet about why other countries feed off our healthcare money and innovations. These other countries save lives because of US innovations. Ever read up on how much money is spent in other countries on research? Try Canada? They leech off our research dollars then Canadians proudly boast their prescriptions are cheaper. That’s because their money wasn’t spent. When things change here because people keep believing socialized medicine is so great…and life and death has a priority lives will be lost all over the world because we provide so much more in the grand scheme of things…we are the rich uncle giving the gift of life and the uncle has a generous and ever expanding arm for now…

    Snippet:They made the US the source of the world’s innovation. Yes, we paid for it. Yes, health care was more expensive here. Yes, lots of the world got a free ride. So what? It was an investment in our lives and productive capacity and it paid off well in the highest standard of living anywhere. ‘A car in every garage and a chicken in every pot’ promise became multiple cars, multiple houses and more food discarded in a meal than many of the world’s people eat in a day.

    Had we waited for Europeans, Asians, Africans or South Americans to accomplish this we might still be waiting for medical specialists, intensive care nurseries, artificial hips, widespread dialysis and the majority of medicines we take for granted. If we waited on others, we’d still be waiting today.

    Instead, we created advances and not only did we benefit, we exported our science and gained good will from it. We donated medical services and products during times of national disasters and wars. Our vaccines prevented – even eradicated – diseases that might have infected us. Our medicines, even when sold at lower prices in egregiously price-controlled markets – returned some funds to the US and we used them to employ scientists and keep the innovations coming. Our innovative health products industry became one of America’s most consistently able to contribute to a favorable balance of trade.

    Rather than be grateful to those who came before us and encouraged by their courage and foresight to do likewise for future generations, we’re taking a different and distressingly unproductive tack today.  We’re ungrateful, unwilling to invest and especially unwilling to allow failure – an occasionally inevitable outcome of trying to make things better.  Some of us are ‘medical toursits,’ traveling to other parts of the world for cheaper care that is so today because those health systems were not the innovators – ours was. They merely ‘shopped’ for the best our innovation produced and replicated it.

    • Paul Watson

      Have a look at

      And tell us whether you think US healthcare is always safe and superior, and that the rush to install and use the latest technology – often in the pursuit of dollars – is always sensible.

      • Alice

        Paul you have certainly asked the right person. I have two children who have received radiation. The side effects are horrific, and because each case was aggressive it did no good (actually, caused more harm than good). But if you click on my name and go to my Twitter you are taken to the three posts in my blog and on the first one I link to a video with a Cleveland Clinic doctor showing the MRI with the inoperable brain tumor (it’s old, and I am young:) ). Then the second one is the letter I wrote to our doctor about the emotional aspect of radiation.

        And my daughter is the recipient of an arrogant doctor’s negligence…..the doctor was cited (I share that because doctors usually barge in to cast doubt on what I share…it’s provable and the other doctors know the error was costly….you lose 8 months and you could lose your life…that’s why waiting lists are killers).

        Radiation? It’s deadly…….horrible stuff…..American healthcare perfect? No healthcare system is perfect, but the mistakes are higher elsewhere.

        • Paul Watson

          ‘No healthcare system is perfect, but the mistakes are higher elsewhere.’

          This is not true – American medical error rates are higher than other developed countries. For example, the ‘adverse event’ rate in surgery is about twice as high in the US as in the UK. I can provide refs for this. I take it you have none.

  • Maria

    Hospice is not inhumane. it is the reasonable answer to this problem. It is even in sync with religious beliefs. CPR and life-sustaining treatment for someone who is dying is “playing God.” and does nothing but line ins company’s and health care systems’ pockets. Letting nature take it’s course has always been God’s remedy. As with everything else in life, when we go against God, we get ourselves into deep trouble..

  • Maria

    Regarding who will regulate people going to hospice versus aggressive treatment. This is America, so the consumer is always right. The answer is education about hospice, getting more medical and financial facts out there As with everything else we do, once things catch on, people will increasingly make the hospice decision as has been already going on for several years now.

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