In a New York Times op-ed, Steve Rattner, former counselor to the secretary of the Treasury in the Obama administration, made the following statement: “The big money in Medicare is not to be found in Mr. Ryan’s competition or Mr. Obama’s innovation, but in reducing the cost of treating people in the last year of life, which consumes more than a quarter of the program’s budget.”
Most millenials have not had to deal with a dying parent to this point, but this is not so for baby boomers. Our parents are in their late 70s and older. These are the years that health care expenditures begin to skyrocket. After 50, dermatology, prostate, breast, colon and heart examinations become an annual ordeal. The tests are very expensive, and, an insurance company, the state or the patient pay all or part of the costs.
Lately, some health care experts have recommended less testing or no testing at all for certain diseases such as prostate and breast cancer. Other experts are questioning the amount of Lipitor being prescribed by cardiologists; in the near future most Americans may be taking Lipitor or other statins to decrease the effects of cholesterol buildup in blood vessels. Are these recommendations based upon the efficacy of the tests/drugs or are they a way to reduce the overall cost of health care? These experts may say men only have a 3% chance of dying from prostate cancer, so why even have your doctor test for the disease? This makes sense unless you are one of the poor bastards in the 3% group.
When your parents are unable to care for themselves and you do not have the wherewithal to do it in your home, the first stop is assisted care living. In the beginning, the services provided are just room and board; but the costs can be $1,100-$3,400 each month. As the services provided increase (more supervision, distribution of meds), the price will rise. When death is imminent, hospice costs are even greater. And, finally, the last days in the hospital can run medical bills into six figures, possibly wiping out entire estates.
So, the questions are: are Americans ready to limit the amount of health care provided to seniors as they age? Can we deal with an insurance company or Medicare turning down reimbursement because the heart medicine prescribed by a doctor will only extend our parent’s life by three or four months? Are we ready to hear that some bureaucrat has recommended no new drugs for our parent because they are going to die soon? Frankly, I do not have answers to these questions, even though I am in the throes of this process for a loved one.
I crafted a living will with my attorney that covers many contingencies, effectively taking these decisions out of the hands of my family. Simply, when I no longer respond, I am not to receive any external support. After the experiences I have recently gone through, I am considering an addendum to my living will to include meds. If I am no longer of sound mind, I want no medications except painkillers.
I agree with Mr. Rattner that huge health care savings can be found in the treatment of older people. Unfortunately, they are frequently being “over treated” because they want to live forever and/or doctors find them easy targets to gouge. This country needs to establish protocols for late life health care. It will be a boon to families financially and emotionally if we do not extend our lives artificially for “too long.”