An important issue within the Healthcare Reform Bill was included, and then excluded in the new Medicare guidelines which took effect on January 1st, 2011. This issue concerns the inclusion of the voluntary ‘end-of-life’ counseling that the government wants to include in the Medicare annual wellness check-up that will now be covered by Medicare Part B. This end-of-life counseling, covered in Section 1233 of the Healthcare Reform Bill passed by the House, but not included in the final bill signed into law by President Obama, is the section of the Healthcare Reform Bill dubbed ‘Death Panels’ by opponents of the bill.
When the 2011 Medicare guidelines were released last fall, the guidelines included ‘end-of-life’ counseling as part of annual check-up. In late December the NY Times printed an article exposing the inclusion of this language in the 2011 Medicare guidelines. There was so much furor raised over this language by the general public that on January 4th, 2011 the White House reversed its position and removed any reference to ‘end-of-life’ counseling in the guidelines. Clearly, the Obama administration wants to include ‘end-of-line’ counseling as a way to decrease healthcare expenditures in the future. Obama admitted as much in 2009 when the healthcare reform debate was occurring,
There is absolutely nothing inherently wrong with providing elderly patients with all the information on treatment choices available to them. I, for one, would like to have every available piece of information possible in order to make the best possible decision for my healthcare. Denying this information to anyone seems unwise, at best, and unethical at worst.
The issue that doctors and patients need to be concerned about is how much pressure the government can place on doctors. When the majority of their income is derived from governmental sources, and the government instructs them to recommend less costly treatment or to forego treatment all together, some doctors will take the path of least resistance. The government will have the power, through licensing and taxing powers to ‘urge’ doctors to provide information to their patients on ‘proper’ end of life choices
Let’s take a look at some of the healthcare economics involved. A common notion is that 80% of all medical costs are incurred in the last 6 months of life. How accurate is this figure? Not taking this figure at face value; a quick web search found that according to the Canadian Institute of Actuaries, through “the Romanow commission on the future of health care, the institute said that 30 to 50 per cent of total lifetime healthcare expenditures occur in the last six months of life.”
In the United States, a study conducted by Donald R. Hoover PHD, et al; entitled:
“Medical Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey”
found that the average annual cost for healthcare in the last year of life “for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for non-terminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death.” And that “last-year-of-life expenses constituted 26 percent of Medicare, and 25 percent of Medicaid expenditures.”
So, if we use the lower number of 30% of healthcare costs in the last six months of life, and that the total annual cost for healthcare in the US is around $2.4 trillion, that would equate to $720 billion in America Obviously, a lot of money is spent on prolonging the life of people another 6-12 months. Now, I am not advocating that this money should not be spent on Americans to extend their life. What I am saying is that people should be allowed to make this important decision based on accurate information provided to them. Some people may decide that they would rather leave the money to their heirs, or to a charity; knowing that they may forego 6-12 months of life. Other patients may decide that they wish to remain on earth as long as possible, regardless of the cost. Either way is fine as long they have the proper information to make the choice themselves (or with their family), and not have the decision made by some governmental bureaucrat.
When the government is paying for your healthcare, then they will have the right to decide which healthcare you will receive. Just look at the education situation in this country, or the funding for highways. When the government controls the money, then they get to make the rules.
The point that I am making is that ‘end-of-life’ decisions should be made by patients, (along with their family) and their doctor. Letting the government decide who receives what healthcare based on actuary tables is just Un-American. But, that seems to be the direction that we are headed.