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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