February 27, 2005

How to Save Medicare? Die Sooner?!

A story in the New York Times proposes that the government consider saving Medicare money by having people die sooner(free subscription required to view):

ALTHOUGH Social Security's fiscal direction has taken center stage in Washington of late, Medicare's future financing problems are likely to be much worse. President Bush has asserted that the Medicare Modernization Act, which he signed in 2003, would solve some of those problems - "the logic is irrefutable," he said two months ago. Yet the Congressional Budget Office expects the law to create just $28 billion in savings during the decade after its passage, while its prescription drug benefit will add more than $400 billion in costs.

So, how can Medicare's ballooning costs be contained? One idea is to let people die earlier. (emphasis added)

I've seen clients cited by regulators for failure to provide necessary care and services to a dying person--so there is merit in discussing what degree of life-prolonging care should be given people at the end of life. However, what this article seems to propose is that the government affirmatively do something to withhold life-prolonging treatments in order to save money.

I think that this is a slippery slope.

If the goverment controls such issues--trumping health providers and family--we will have a problem. This sort of "gate-keeping" is precisely what has caused an uproar over HMO's.

Do you believe that the government will be a better gate-keeper of treatment and services than HMO's?

If so, I want to introduce you to BLANDINE ALLAKI the daughter and Mister Desmond ALLAKI the sonof H.R.H CHIEF WILLIAMS ALLAKI of the ex- king of mende tribe Nigeria. She has an investment proposal for you.

Moreover, the article points out:

For the last few decades, the share of Medicare costs incurred by patients in their last year of life has stayed at about 28 percent, said Dr. Gail R. Wilensky, a senior fellow at Project HOPE who previously ran Medicare and Medicaid. Thus end-of-life care hasn't contributed unduly of late to Medicare's problems. But that doesn't mean it shouldn't be part of the solution. "If you take the assumption that you want to go where the money is, it's a reasonable place to look," Dr. Wilensky said.

Slippery slope alert!

Making determinations about life-prolonging treatments is complex and delicate. It's not just about the medicine or the money. It's also about ethics and morality. Get the government directly involved in such decisions and it will soon be using a backhoe where a teaspoon will suffice. That's about as complex and delicate as the government ever gets.

Lately, I've been thinking about these issues in the context of the Pope. If the government were in charge of determining life-prolonging treatments on his behalf, would he be alive today? Despite his infirmity, he has continued to work and produce writings on such matters as changes in the media and the rise of blogs.

Of course, his situation is far different than the situations of many people today who reside nursing homes. For them, heroic measure such as tracheotomies may not be appropriate.
But the point is, should the decision be taken from you, the family, the attending physician and the community in which you live, and placed in the hands of the federal government?

I say no. In my opinion, if the government makes money the primary consideration in decisions about treatment of the elderly and infirm, our society will begin to devalue the elderly, infirm and disabled.

I keep going back to what Peggy Noonan wrote about the reason the Pope has refused to retire and insists on showing us in his extremis:

What should the pope's suffering tell us? Several things, said Mr. Novak. He is telling us it is important in an age like ours to honor the suffering of the old and the infirm. He wants us to know they have a place in life and a purpose. He not only says this; he lives it. He was an actor as a youth; he teaches by doing and showing, by being. His suffering is a drama he is living out quite deliberately. John Paul stands for life, for all of life. He wants to honor what the world does not honor.

Those of you who make your living caring for the elderly, infirm and disabled--isn't honoring the lives of the elderly, infirm and disabled precisely what you do?