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By Paolo von Schirach
July 8, 2012
WASHINGTON – Probably the biggest perversion embedded in the segment of US health care subsidized by the Government (Medicare, Medicaid, Disability) is that it is blank check, an open invitation to overspend on routine treatment and in particular in desperate cases in which doctors try the utmost with the net result of prolonging someone’s life a little bit; but at an enormous cost. In other words, both doctors and patients know that the Government picks up the bill. So, why economize, when there is even a remote chance to improve a clinical outlook?
How much is enough care, in desperate cases?
It goes without saying that doctors should always do their best to save lives. But there is absolutely no reasonable limit to this zeal when doctors know that neither the patient nor his or her family will pay the bill for all this care.
As a result of this system, we get really shocking statistics. According to data gathered by the WSJ, when we are looking at hospital care provided by Medicare, just 10% of the recipients are responsible for 64% of total spending. This is a staggering percentage. This means that care for the relatively few super sick is by far the main component of total costs. Again, this is possible because there are no breaks and thus no constraints on more and more treatments, even in the most desperate cases, when more and more efforts are really futile.
Change is impossible
Is it possible to correct this aberration? Probably not, within the current system. Any attempt to introduce standards of care that would inevitably limit medical intervention and therefore costs, especially in “near the end” cases, would be immediately called a “death panel”. The Government would be accused of having established euthanasia as a way to save money and so on. This will never work.
In truth, deciding when to stop treatment is a really difficult issue, involving social values, morality and of course religious beliefs. Who can “objectively” decide when “enough is enough” and that it is alright to let a patient die instead of trying some other super expensive treatment? No one can. And this is why no one does. As a consequence, there being no limits on care, these costs skyrocket reaching absurd dimensions.
Quite frankly, the only way to limit these expenditures would be to radically transform the system. Right now neither the hospitals nor the patients bear the costs, so there is no incentive to stop treatment, at any point, whatever the chances of making a real difference.
In a different world, beyond a certain point care recipients pay
However, in a different world, while there would still be public financial assistance, especially to the truly needy, it would not be limitless. In this new environment, the shared awareness (meaning doctors and patients) that at some point there will be a bill to pay, because after a given amount the Government will no longer pick it up, would transform the entire approach to treatment of severe and –in many cases– desperate cases.
If not, let’s have an honest debate
If this “cost-benefit” approach is deemed callous when we deal with human lives, then we have to be frank and openly and publicly declare that: ”We, the taxpayers, endorse limitless public payments for any treatment, even the most improbable, until the patient is alive”. While this is what is going on in practice, I am not sure that we have honestly debated the issue and reached the consensus, as a society, that this is exactly the way we want it.