Even in the age of advanced healthcare directives and living wills, Americans still must cope with a dilemma when it comes to end-of-life healthcare for themselves or their loved ones. Consider the fact that Medicare pays as much as $55 billion annually for physician and hospital bills during the last two months of patients’ lives. That’s more than the budget for the Department of Homeland Security, or the Department of Education. Estimates are that 20 to 30 percent of these medical expenses usually have no meaningful impact. The federal government pays for a majority of the bills with no questions asked. Medicare spends nearly 30 percent of its budget on beneficiaries in their final year of life.
Given this information, the question is whether extending someone’s life is worth the money it can potentially cost. The solution potentially could have been a snap for Congress when it passed the Patient Protection and Affordable Care Act (ACA). Unfortunately, the previously bipartisan issue quickly became a political hot potato.
According to Dr. Ira Byock, it costs as much as $10,000 a day to maintain someone in the intensive-care unit, even if the patient remains there for weeks or even months. “This is the way so many Americans die. Something like 18 to 20 percent of Americans spend their last days in an ICU,” Byock said. This discussion raises the philosophical issue of the value of human life. According to Byock, “While many people question spending a lot of money to prolong the life of an elderly, frail patient, it was perfectly logical for a frail person to value life extension as much as a perfectly healthy person. With advances in medical care, it can be argued that the value of hope has been increasing along with the statistical odds of staying alive until a cure is found.”
Over-treatment, according to Byock, is an unfortunate side effect of medical advances. “We have enormous scientific prowess and remarkable diagnostic and treatment,” so that when you are admitted to the hospital, the system “moves you quickly towards the next diagnosis and then the next diagnosis after that for the next component problem in a whole picture that few people will see. It’s a dysfunctional system that feels like a conveyor belt. We have a disease-treatment system rather than a healthcare system caring for human beings.” Byock notes that the same system can lead doctors and patients to regard any reduction in treatment, or even accepting that patients are going to eventually die, as failure. There are amazing ways to combat disease and extend life. “That’s all well and good. The problem is, we have yet to make even one person immortal,” Byock concluded.
Dana Goldman, director of the Schaeffer Center for Health Policy and Economics at the University of Southern California and founding editor of the Forum for Health Economics and Policy, has a difference approach. According to Goldman, “We think of healthcare as an expense, but we really should be thinking of healthcare as an investment. We want to invest where we have the greatest return. I would put prevention in that bucket. But the way we do it now, no one has an incentive to invest in things with a long-term return.”
