Want to start saving money in health care?

[John Adams]

•The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.

 

•Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

 

"People are actually now sicker as they die," and some find that treatments become a greater burden than the illness was, said Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center. Families may push for treatment, but "there are worse things than having someone you love die," he said.

 

http://www.usatoday.com/news/health/2010-0...gle+Feedfetcher

[SageAgainstTheMachine]

I'm convinced that one of mankind's greatest ills is the fear of natural death.

[KD in CA]

In my area, they are talking about closing the only local Hospice where both my parents died. My Mom never went to a hospital and spent her last 3 weeks in the Hospice -- the people there couldn't have been nicer or more supportive. The environment was wonderfully comforting for both her and the family as we kept a bedside vigil.

 

My Dad spent a month in the awful, depressing cancer ward at Sloane-Kettering at the end and we still had doctors talking about aggressive treatments and 'weeks or months' of time less than week before he died. It was like pulling teeth to get anyone to even acknowledge that he was in his final days, much less get them to state that they agreed we should end the treatment. We finally got him to the Hospice 48 hours before he died.

 

Guess which situation one was infinitely easier on the patient and family and cost the taxpayers hundreds of thousands of dollars less than the other?

[birdog1960]

http://www.usatoday.com/news/health/2010-0...gle+Feedfetcher

it's a banner day. i wholeheartedly agree. the culprits in many instances are estranged family members who show up at the end feeling guilty and want "everything done for mom" because of their own negligence. there are statistical tools available that can give quite accurate and precise odds on a patient with multi system organ failure leaving the hospital. less than 1% seem a reasonable cut off (heck, .1% would be a start) but many people, especially the elderly would disagree. and then there would be the religious arguments making those surrounding persistent vegetative states look simple...

[John Adams]

In my area, they are talking about closing the only local Hospice where both my parents died. My Mom never went to a hospital and spent her last 3 weeks in the Hospice -- the people there couldn't have been nicer or more supportive. The environment was wonderfully comforting for both her and the family as we kept a bedside vigil.

 

My Dad spent a month in the awful, depressing cancer ward at Sloane-Kettering at the end and we still had doctors talking about aggressive treatments...

 

Guess which situation one was infinitely easier on the patient and family and cost the taxpayers hundreds of thousands of dollars less than the other?

 

My wife is a hospice social worker and it shocks me how few people choose hospice care. I would much rather die in my home, not in pain, with the hospice workers helping me manage my end of life care, than in a hospital stuck full of needles.

 

This is one of those areas where we in the US are WAY behind Europe. Oddly, a lot of religious people are opposed to hospice, which is probably why it's reputation is so bogged down with negative perception.

[John Adams]

it's a banner day. i wholeheartedly agree.

 

A banner day? Do I know you?

[birdog1960]

recent legislation that passed with broad support allows hospice patients to enroll but still choose aggressive intervention while in hospice. this.i believe, is a backwards step.

[birdog1960]

Dr. Byock at Dartmouth is a brave and articulate spokesman. his position is not all that popular and that's why it's unlikely the politicians will pick up the banner.

[/dev/null]

A banner day? Do I know you?

 

Bruce Banner?

[Jim in Anchorage]

Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

They need to check who they admitting under Medicare. Looks like 302 sneak in.

[KD in CA]

Bruce Banner?

 

David Banner. Don't make him angry. You wouldn't like him when he's angry.

[birdog1960]

here's a hypothetical to test your committment to this issue: ralph wilson has demetia (in actuality at age 90 the odds are 1:1), pneumonia, renal failure and congestive heart failure. all are reponding poorly to conservative treatment. do you want medicare to pay for heroic measure if he says he wants them (and you know he does)?

[/dev/null]

David Banner. Don't make him angry. You wouldn't like him when he's angry.

 

Bruce Banner > David Banner

[birdog1960]

here's a hypothetical to test your committment to this issue: ralph wilson has demetia (in actuality at age 90 the odds are 1:1), pneumonia, renal failure and congestive heart failure. all are reponding poorly to conservative treatment. do you want medicare to pay for heroic measure if he says he wants them (and you know he does)?

c'mon. nobody? how bout if he is refused but agrees to pay cash for the heroic measures? i think i can guess your answers but what about the implications?

[LewPort71]

I'm convinced that one of mankind's greatest ills is the fear of natural death.

 

 

Well said, Sage.

 

When my mom's cancer came back for the third time, she told the Doc "Let nature take its course. No more chemo or treatments." She passed in her sleep at home. She had no fear.

[OCinBuffalo]

This is a difficult issue to be sure.

 

My own experience was that both of my grandfathers were turned into science experiments in the last 6 months, with no value added to their lives, or ours. Instead we had doctors going all out spending God knows what, and simply prolonging the inevitable. One of my grandfather's had Alzheimer's, the worst stage, which means you are going to die within the year, no exceptions. With this knowledge, they were still talking about saving kidneys and they installed a pacemaker? So...he could go on...suffering by not knowing who we were, where he was, how to get to the bathroom, most of the time?

 

The real problem is: the "Death Panel" concept. Obviously, we see that it is a political death sentence for anyone who supports it. And, it's easy for the usual far-right religious nuts to pile on if anyone dares talk about not "doing everything".

 

Another problem is: nobody, and I mean nobody, knows how they are going to feel about this kind of death, until it is upon them. Plenty of people have faced death. But, not this kind. Health care proxies and other tools are useful, but they simply don't prepare the person, and more importantly, they family for this kind of long suffering death.

 

Another problem is: why in the hell should I trust government employees with this decision? I wouldn't trust the average government employee with what are "simple" tasks in my company, and I sure as hell don't think they are capable of, never mind if they should, being in charge of something like this. However, I want to be fair: Ok, so let's say we have a few good ones. Let's even say 30% are elite people that could easily get a job and be successful in the corporate world. If that # holds, or even if we go out of our way to get the best people in the "treatment decider" role, the best we can hope for is: 50% of them being good. Sorry, but flipping a coin isn't good enough.

[Jim in Anchorage]

Too Verbose. Try again.

[birdog1960]

This is a difficult issue to be sure.

 

My own experience was that both of my grandfathers were turned into science experiments in the last 6 months, with no value added to their lives, or ours. Instead we had doctors going all out spending God knows what, and simply prolonging the inevitable. One of my grandfather's had Alzheimer's, the worst stage, which means you are going to die within the year, no exceptions. With this knowledge, they were still talking about saving kidneys and they installed a pacemaker? So...he could go on...suffering by not knowing who we were, where he was, how to get to the bathroom, most of the time?

 

The real problem is: the "Death Panel" concept. Obviously, we see that it is a political death sentence for anyone who supports it. And, it's easy for the usual far-right religious nuts to pile on if anyone dares talk about not "doing everything".

 

Another problem is: nobody, and I mean nobody, knows how they are going to feel about this kind of death, until it is upon them. Plenty of people have faced death. But, not this kind. Health care proxies and other tools are useful, but they simply don't prepare the person, and more importantly, they family for this kind of long suffering death.

 

Another problem is: why in the hell should I trust government employees with this decision? I wouldn't trust the average government employee with what are "simple" tasks in my company, and I sure as hell don't think they are capable of, never mind if they should, being in charge of something like this. However, I want to be fair: Ok, so let's say we have a few good ones. Let's even say 30% are elite people that could easily get a job and be successful in the corporate world. If that # holds, or even if we go out of our way to get the best people in the "treatment decider" role, the best we can hope for is: 50% of them being good. Sorry, but flipping a coin isn't good enough.

the public and the profession would demand that doctors dominate the "panels". a patient's own family doctor would almost certainly be intimately involved. medicine is about as close to a meritocracy as you'll find in the US. 90%+ of successful med school applicants are in the top 10% academically and even some of these wash out during the rigors of training. reputation is mostly based on performance and i doubt poor performers would be asked to sit on such a panel. therefore, i feel your fears of incompetents running the show are unfounded.

[OCinBuffalo]

the public and the profession would demand that doctors dominate the "panels". a patient's own family doctor would almost certainly be intimately involved. medicine is about as close to a meritocracy as you'll find in the US. 90%+ of successful med school applicants are in the top 10% academically and even some of these wash out during the rigors of training. reputation is mostly based on performance and i doubt poor performers would be asked to sit on such a panel. therefore, i feel your fears of incompetents running the show are unfounded.

Then why didn't the "progressives" who wrote the health care bill insert this simple solution, and instead, have government bureaucrats make the decision?

 

Answer: Because doctors can't be controlled, and because they know that they can threaten a bureaucrat and that bureaucrat will do whatever is demanded, since, the bureaucrat only has that job due to the "progressives" that put him there.

[birdog1960]

Then why didn't the "progressives" who wrote the health care bill insert this simple solution, and instead, have government bureaucrats make the decision?

 

Answer: Because doctors can't be controlled, and because they know that they can threaten a bureaucrat and that bureaucrat will do whatever is demanded, since, the bureaucrat only has that job due to the "progressives" that put him there.

ever heard of howard dean?