patrick.net

@CBOEtrader, End of life care is the low hanging fruit; everyone knows it. Maybe there will be a serious discussion after the next election cycle. Research suggests that this wouldn't fall under the category of rationing (bring on the death panels)...
The reality is that patients want to have a say in what happens to them when they're sick and, more often than not, they don't want heroic and often hugely costly measures to save them. In the new study, researchers found that more than 90 percent of the adults who had living wills requested either limited care or "comfort care" at the end of life. Only 1.9 percent (a total of 10 patients out of 3,746) asked for "all care possible." Doctors must acknowledge this and have honest and informative conversations with their patients. In another study, published in 2008, researchers found that end-of-life discussions resulted in less aggressive care—including ventilation and resuscitation—and earlier hospice enrollment, which equaled better quality of life for patients.
I'll give you this, though, the first study may be biased as, by its nature, it selected the population willing to think about end of life issues (by virtue of them having living wills).

I fail to understand why we go to the expense and red tape of Death Panels?

Why can't their family members leave their elders out in the woods to be eaten by wolves?

I suppose we need them for people with no directly identifiably living relatives though.

Soylent Green

End of Life Care is a huge money-making endeavor. Hospices are paid $140/day (minimum) to provide care for patients, which translates into a weekly nursing visit, aide visits 3x/wk, chaplain visit monthly and social work visits every month, plus medications & supplies - even if the patient is in a nursing home receiving 24 hour care. Hospices are springing up everywhere, and their marketing practices are unbelievable. They'll tell you that you don't have to be dying to receive hospice care.

Hospice does have its place, but as long as they're allowed to sign anyone one and figure it out later, hire non-medical marketers to evaluate a patient, and are paid the same amount whether the person is already receiving 24 hour care in a board & care or nursing home, this care is expensive and often redundant. Physicians should feel comfortable to prescribe end of life meds without the added expense to the system of placing the patient on hospice.

People do want to be comfortable at the end of their lives - but they should have options beyond someone shoving hospice down their throat. Especially if they're in a hospital that owns a hospice or home health company they're pushing on the patient, or if the doctor is the medical director of the hospice. There's a lot of reform needed.

Might I add that the biggest changes to hospice occured during the republican administration? There's huge home health/hospice lobby...

elliemae says

Might I add that the biggest changes to hospice occured during the republican administration?

and therefore are bad

AdHominem says

elliemae says

Might I add that the biggest changes to hospice occured during the republican administration?

and therefore are bad

No, they're bad period. But since some people around here consistently assign blame I thought I'd head that one off at the pass.

Hey, you are the one who brought up the Republican association. Anyways hospice is only bad because it is another program where the recipients get benefits that they don't pay for, while the government pays for "services" that likely would not be paid for by anyone if they had a choice. In other words it is NOT a free market, just another wealth transfer scheme dressed up in a bleeding heart social program.

AdHominem says

Hey, you are the one who brought up the Republican association. Anyways hospice is only bad because it is another program where the recipients get benefits that they don’t pay for, while the government pays for “services” that likely would not be paid for by anyone if they had a choice. In other words it is NOT a free market, just another wealth transfer scheme dressed up in a bleeding heart social program.

we all pay medicare taxes out of our paychecks. hospice patients get benefits that they do pay for - and the program saves money. It's just rampant with fraud. People would (and do) pay for hospice if they need to, and people choose to have hospice services. Once again, you don't know whereof you speak.

I don't even need to say that last part. If you're speaking (posting), it's a sure bet you haven't a clue what you're talking about.

Hospice care giver ..... A tuffer job I can't imagine.

The person who is actually caring for the dying person is the hero - the hospice comes in at most an hour a day. The other 23 are provided by the caregiver, usually a family member. It's unpaid, hard and emotional work.

I can't tell you how many times I stood in a patient's house, with a teeny little wife and a large man dying in the bed, wondering how they do it? Seeing them get neighbors to help out a little but otherwise being on their own. It's amazing how they do it, and I hold the highest respect for the 24-hour caregivers.

elliemae says

I don’t even need to say that last part. If you’re speaking (posting), it’s a sure bet you haven’t a clue what you’re talking about.

When all else fails you always have that to fall back on. So you have that going for you....

elliemae says

and the program saves money. It’s just rampant with fraud.

isn't that an a contradictory statement?

AdHominem says

elliemae says

and the program saves money. It’s just rampant with fraud.

isn’t that an a contradictory statement?

No.

says

The primary role of government is law enforcement, punishing evil, protecting our borders and citizens from without and pursuit of liberty, life and happiness.

It's pretty hard to pursue life and happiness when you are dying of cancer... So, I'd say keeping citizens healthy is a role for government.

tatupu70 says

It’s pretty hard to pursue life and happiness when you are dying of cancer… So, I’d say keeping citizens healthy is a role for government.

Some people would define happiness by having a big screen TV. Should the government provide that for its citizens?

RayAmerica says

Some people would define happiness by having a big screen TV. Should the government provide that for its citizens?

So, in your mind owning a big screen TV is the same as being alive?

tatupu70 says

So, in your mind owning a big screen TV is the same as being alive?

Read very, very slow. I suggest one word at a time. I said "some people" would define happiness by having a big screen. Meaning, that there are people out there that think the government is the provider for all their wants and needs. Furthermore, the actual quote is "life, LIBERTY and the PURSUIT of happiness." Taking your logic to the next step (and there will always be another step), a person that has a toothache can't "pursue" happiness because they are in pain. Should the government step in and take care of their toothache ... or headache ... or whatever? And what about the money that is removed via taxation from producers in order to help these people pursue their happiness? Is that infringing on their liberty?

OK--

I read it VERY slowly. But, I still come to the same conclusion. So, what you're saying is you have to find where to draw the line, right? I guess I'd say that keeping its citizens alive does not cross the line. Buying them a big screen does.

It would actually reduce costs for the country as a whole. Lost productivity costs would outweigh the extra health care costs...

What about people that are obese? Should we all take care of the fatties of the country that can't stop eating Big Macs, greasy French fries and ice cream? Or those that have lung cancer that just happened to have smoked for the last 30 years? Where does the list end?

Should we pay for people who lack compassion and believe that they're better than many other people, while claiming to be a victim of the system? Angry people who yell A LOT on interweb forums? Where does the list end?

elliemae says

Angry people who yell A LOT on interweb forums? Where does the list end?

You can count on me. I think you should be covered.

RayAmerica says

What about people that are obese? Should we all take care of the fatties of the country that can’t stop eating Big Macs, greasy French fries and ice cream? Or those that have lung cancer that just happened to have smoked for the last 30 years? Where does the list end?

It doesn't end. You cover everyone. And along with that you develop incentives/penalties to help people eat healthier and stop smoking.

tatupu70 says

It doesn’t end. You cover everyone. And along with that you develop incentives/penalties to help people eat healthier and stop smoking.

So you favor rewards/penalties re: lifestyle choices?

Yes--we already have this.