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Editor's Note You've heard it many times already, from politicians, journalists, ethicists, and economists. Too much is spent on health care at the end of life in the United States. So you think so? The Alliance for Aging Research in Washington decided to test some misconceptions about the financial and health impact of older Americans during their last months of life. They looked at the most current Medicare data, statistics, and the professional literature and put together a report about the real cost of the last year of life. Most Americans probably think older Americans are responsible for a lot of expensive, high-tech treatment that is ultimately futile. The report says, “The healthcare debate is haunted by a harrowing image of very old men and women hooked up to beeping, wheezing life-support machines monitored by [those] heedless of the costs and insensitive to individual human suffering. This picture lies at the heart of the debate over such diverse issues as Social Security, Medicare costs, physician-assisted suicide, healthcare rationing, and medical research priorities.” I hate to hear people complain that the majority of healthcare dollars are spent in the last six months of life. (When would you like it spent on you? When you're running marathons?) These folks don't understand that we don't have a special high-tech meter that can tell us when our best efforts will work and when they won't. In fact, the data shows that many older people who receive aggressive care survive and do well for a long time. Limiting acute care at the end of life would save only a small fraction of the country's healthcare costs. Gene Cohen, PhD, MD, a geriatrician and the chairperson for the report, said, “It appears that age alone is not a reliable predictor of medical care outcomes or expenditures, nor is health care at advanced ages usually characterized by recourse to futile and expensive technologies.” It's time to separate fact from fiction. Barbara Bronson Gray, MN, RN |
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