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September 19, 2014 at 03:40 AM
Debate about health policy in the United States seems to be moving toward the idea that limiting public spending on care for older patients in grave conditions is a necessity.
Just a few years ago, some opponents of the legislation that became the Patient Protection and Affordable Care Act (PPACA) tried to block enactment by arguing that the PPACA treatment effectiveness research program would lead to “death panels.” Times have changed.
A few weeks ago, one team concluded that 11 percent of patients in hospital intensive care units (ICUs) maybe getting futile care, and crowding out patients with a better chance of survival.
Uwe Reinhardt, one of the best-known health policy economists, said the country needs to package public health care for the poor and reference-based priced care for middle-income people in such a way that Congress can ration care without publicly admitting that it’s rationing care.
The Institute of Medicine — which sounds like an august body of sages that dresses in white robes and sips ambrosia on Mount Olympus, while discussing health policy issues in Attic Greek — has suggested in a report on end-of-life care that the country needs end-of-life care quality statistics, and that one focus of the death care statistics should be encouraging advance planning, to reduce use of unnecessary care and of unwanted care. The institute didn’t even balance the idea of reducing use of unwanted care with a phrase or sentence, suggesting that some people might use planning to request that they get as much death care as circumstances permit.
Personally, I would want to minimize the use of death care on myself. One of my relatives who saw her mother die of cancer thinks of Dr. Jack Kevorkian — a strong advocate of assisted suicide for people with serious health problems — as a saint.
