The New York Times reports on the next great cost saving measure in the US:
Medicare, the federal program that insures 55 million older and disabled Americans, announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.
Time to prepare the ice floes for Grandma before global warming forces us to use more expensive methods…
Or this is a simple, minor technocratic fix that enables people to make more fully informed decisions about their lives, their families and their expectations while they are not under pressure of contradictory information and values?
We know a few things about death. It happens to everyone. The months immediately preceding death are statistically the most expensive time on average, we tend to overtreat and over-intervene at a heroic basis before death even as the person being intervened on does not want heroic treatment. Death and the possibility of heroic intervention to avert death can and will tear apart families.
Talking about death is important, and that means paying for providers to talk about death.
Imagine a town of 50,000 Americans where 96% of those who die have signed an “advance directive” codifying their conscious decisions about how they would like to die. This is quite an accomplishment given we haven’t been able to move the needle at a national level beyond 30% over the past 30 years….In La Crosse the simpler, cheaper and more accessible innovation that was good enough to get the job done was the ancient art of conversation. Hmmmm. Talk maybe cheap… but effective….By 1995, 85 percent of people that died in La Crosse County had an advance directive and by 2009 the number had reached 96 percent–more than three times higher than the national average. Nationally, the average cost for a patient’s last two years of life is $26,000 (in some hospitals average costs run as high as $65,000) the average cost in La Crosse, is just $18,159. More importantly, knowing patients’ wishes ahead of time ensures the best possible care and relieves debilitating emotional and financial stress for families. Family members don’t have to debate about what their loved one would want for treatment and avoiding decisions made in the spur of the moment.