Can I interrupt with two anecdotes on health care costs ?

[hedgehog]

Now, this is anecdotal evidence only, but one of the oddest statements that comes up over and over again when discussing health care costs, especially Medicare is that X% of the costs occur in the last year of life, or Y% of costs occur in the last week of life. I've never understood why people make such a big deal out of this. Most people don't need costly medical care until they are very ill. People who are dying tend to be very ill.

My mother had two hospital admissions since last Spring due to overall weakness/trouble breathing. She was admitted one last time, and this time we (family, doctors and nurses) honestly thought she was going to get a good diagnosis and maybe a treatment to carry her over a few more years. Instead, she slipped downhill. When it was clear that she wasn't going to recover, we followed her wishes, expressed over the years and expressed at that time, and had her removed from the ICU and put on palliative care. She passed quietly before we could arrange hospice.

A friend's grandfather was taken to the hospital suddenly last week with a hemorrhagic stroke. Things looked pretty good; he was alert, speaking and assisting with his care. He was scheduled for some minor brain surgery (if there is such a thing!) to clip off another aneurysm and install a shunt. As far as I knew, the surgery went ahead, he did well and was recovering. Yet this morning, he passed away quietly in the hospital.

So, two people, neither of whom was expected to die, died in the hospital after a week of expensive care. I don't see how these costs could have been avoided. We cut my mother's costs considerably by having her out of the ICU the last two days, but she still spent four days in ICU. We were prepared to see that she was dying and also prepared to stop treatments that would only distress her and delay the process. I guess the moral of the story is that while we could limit the costs, we couldn't eliminate them.

[Catherina]

1. I'm not sure why when I rec'd this, it's still at 0. Thanks for sharing. Rec'd. n/t

[kickysnana]

2. My Mom went to the ER from home & was deemed endstage COPD three years ago...

They adjusted her medicines and the prognosis was at least 6 months but possibly another couple years without a flu or pneumonia. She transferred from the hospital to the nursing home, palliative care. She passed in three days.

She was in the hospital for 2 1/2 days of tests to get the determination. She was fragile should have stayed in the hospital rather than moving to the nursing home for at least another 24 hours (I was overruled by my Dad). Doctor looked in my face and told me she would do fine. I for one was waiting for her to get a bit stronger before I said my final goodbyes because we loved each other but disagreed on many things. It was January and the weather was horrible and parking there was on city streets sometimes a few blocks away and I am disabled. If she had stayed in the hospital she may have died anyway but I could have spent more time with her and she was not strong enough to be moved right then and I knew it.

A neighbor about 10 years younger had anaphylactic shock during a kidney scanning procedure. They had to restart her heart, put her on a vent and her kidneys failed. After a bit the doctor told he family that she was not going to recover and suggested turning off the machines. They wanted to wait until the next day to make a decision and in the morning she woke up and after two months came back to her apartment, resumed as head of the Senior Association for another year and is still here coming to many functions.

It takes time to make the right decisions and costs are trumping judgment in some cases.

Thanks for sharing. This will be an ongoing debate.

[hedgehog]

4. Costs may be a consideration for some, but the doctors I've encountered

try to do their best for their patients. Sometimes, they hang on to hope long after the family has accepted the truth.

[Jokinomx]

3. First my condolences for your loss...

although in the two cases you sited nothing should or could be changed. However, my one older brother was diagnosed with stage 4 brain cancer a couple of years ago. He had good insurance. Doctors were foaming at the mouth wanting to get radiation therapy started. He had been given 6 months to live without radiation and maybe 8 to 9 months with radiation. Each weekly treatment could cost up to $40,000..... siblings with the Dr. asks how long these treatments would last... and he said until he died. To make a long story shorter... zero of the 14 brothers and sisters wanted him to have the treatments. We all figured he would be better enjoying what time he had left without radiation compromising his quality of life. In the end he refused not because he didn't want the treatments...but because he had poor teeth and b4 all this occurred he was going to finally get his teeth fixed. This meant more too him than life, because the Dr. said he couldn't do the radiation therapy until after all the teeth were pulled and he had healed some. So that is what my brother decided... to get his teeth fixed first. Then in 3 or 4 weeks he would start the radiation. Well, the radiation Dr just about blew a gasket. He just saw 40 k a week for 6 to 9 months go out the window. My brother ended up not getting either as ignorant nurses at the nursing home allowed his glucose levels to drop so low after they took him off of steroids he died. So he didn't have to suffer as our medical profession would have had him do... all for a buck. It was a blessing that he passed early on and didn't suffer undo pain not to mention the pain of the family living this nightmare with him.

a side note... while my brother was waiting to see the radiologist, a 30ish man rolled into the reception area and asked to make an appointment for radiation for his lung cancer. The receptionist told him that there was nothing that they could do to help him and he was told to leave. After he left my sister looked at the receptionist and asked why he wouldn't be treated? She was told that he didn't have insurance and this was his 2nd time with lung cancer.

Also... even though he saved his insurance company most likely a couple of hundred thousand dollars not taking the treatments....they refused to pay his final two weeks for a nursing home because they said he could live at home. Fuckers.

Peace

[hedgehog]

5. Even if money isn't involved, the relative value of quality of life

vs quantity of life is very much an individual choice. In our case, my mother probably could have lived a few days longer in a semi-conscious state on the respirator, but for what? One brother explicitly told me that it would take him several days travel time to get to the hospital , but that we were not to take that into consideration, that my mother's comfort was the most important factor. She wasn't getting stronger, she wasn't going to get stronger, and she wanted off the machines.

Many (most?) doctors will push to try one last treatment, even against the odds, because of that one person who should have died but who recovered. I can't blame them, they don't want to see any patients die.

[DragonSlave]

6. I first heard this from Robert Kuttner, it isn't con propaganda at all

I think you are taking this statement personally, unfairly applying a sinister motive to it, and ignoring its function in the healthcare discussion.

This statistic is important for description of healthcare costs. If you are trying to set up a healthcare system you need to know who is paying and who is receiving services in order to evaluate the incentives that the system creates and that system's fairness. It also comes up in discussions of end-of-life care.

This statistic is crucial in thinking about healthcare. It isn't composed primarily of costs that recently healthy young people incur. It is mostly the result of long declines in health that culminate in severe health declines and corresponding costs in older Americans. It is often used to argue for increased funding of preventive care. But if we let the medical service providers make the decision based on their finances they will not be in favor of preventive care if there is a more expensive (and therefore profitable) treatment down the road.

So then there is a question of who should pay for healthcare. Here it is important to have the data in order to actually make the arguments. If you say that we should all pay equally, that requires some argument that the young should pay for the care of the old. It isn't hard to rationalize this. I think it is actually fair for the young to subsidize the healthcare costs of the old, but isn't it better to have a fact-based discussion?

If you think about a thrifty person dying, maybe they don't wish to spend a big chunk of their fortune on expensive treatments that will only marginally prolong life. We can respect their wishes by having systems in place to give people more control over how they die. My state Rep, Earl Blumenauer, worked to get an end-of-life care and consulting amendments included in healthcare reforms but he ultimately lost that battle. The Republicans, of course, spun these as "death panels".

I first encountered the statistic in Everything for Sale by Economist Robert Kuttner.