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BY MURRAY SABRIN
COMMENTARY
Death is inevitable. That's the bad news. The good news is that life expectancy in America today is nearly 80 years for both men and women, compared with less than 50 years for all Americans a century ago.
At the beginning of the 20th century, Americans died from several sudden, "acute" illnesses — pneumonia, tuberculosis, diarrhea and enteritis. When an illness occurred, individuals usually lived for only a few weeks or at best several months. The typical place of death was at home, where family members, usually women, cared for the terminally ill. Families paid for virtually all the medical expenses.
Today, when the terminally ill die in America, they usually expire in a hospital, paid for by Medicare and live, on average, two years with a chronic illness — cancer, heart disease, stroke — before death.
David Walker, former chief of the Government Accountability Office and now head of the Peter G. Peterson Foundation, raised the issue of not only the impact of end-of-life costs on the medical system but also of health costs in general: "The perverse incentives that exist in our system are magnified at end of life... We have a system where everybody wants as much as they can get, and they don't understand the true cost of what they're getting. The one thing that could bankrupt America is out-of-control health care costs. And if we don't get them under control, that's where we're headed."Economist William Anderson points out: "The vast amount of medical care in the United States is paid by third parties, be they insurance companies or governments, and that is the root of the problematic situation that exists today in medical care."
Medicare will spend more than $110 billion for the terminally ill this year, and more than half of that amount will be spent on hospitals and associated costs, but Medicare's actual end-of-life outlays may be as high as $150 billion, according to my estimate of the Dartmouth Institute for Health Policy and Clinical Practice's study of chronic illness in America.
Total Medicare costs of treating chronic illnesses in the last two years of life reached a high of $59,379 per person in New Jersey during the 2001-05 period; the national average was $46,412.
In short, not only is it expensive to live in New Jersey, but the cost of dying here leads the nation.
Although patients nearing the end of life have access to the latest diagnostic equipment and treatments, the Dartmouth study researchers assert that medical outcomes are no better and in fact may be worse for patients in high-expenditure regions.
Why? The Dartmouth researchers point out "hospitals can be risky." Patients, especially the terminally ill, "acquire antibiotic resistant infections."
In addition, "greater use of diagnostic tests could find more abnormalities that would never have caused the patient any problem (a condition referred to as ‘pseudodisease')."
Furthermore, "as care becomes more complex and as more physicians get involved in an individual patient's care, it becomes less and less clear who is responsible, and miscommunication — and medical errors — become more likely."
The major conclusions of the research conducted by the Dartmouth study are that at the end of life there is an overreliance on inpatient services, too many visits by specialists, and, in the final analysis, a substantial waste of taxpayer dollars.
Associate Director of Oncology at Robert Wood Johnson University Hospital and practicing oncologist in central New Jersey, Dr. Michael Nissenblatt, underscores a common observation that the Baby Boom generation's health care demands will challenge Medicare.
He believes that physicians, especially oncologists, must offer clear choices to their patients so they can make rational decisions about end-of-life care.
For example, Dr. Nissenblatt says that if patients with underlying life-limiting diseases such as advanced cancer are told that they can be kept alive using extraordinary measures such as a tracheotomy or dialysis, or by embracing other uncomfortable and potentially harmful treatments, most patients would not want the few extra weeks or months of life in exchange. Thus, Dr. Nissenblatt wants both patients and physicians to be better informed about the implications of "unlimited care."
He asserts that "unlimited care" is not compassionate care, but that ethical and compassionate care can be financially responsible.
Dr. Nissenblatt says that truth and compassion must guide physicians in their role as healers and eventually, as enlightened counselors at the end of life.
If health care inflation is 7 percent per annum for the next decade, then end-of-life costs could reach at least $300 billion by 2020, and total health care costs would top $5 trillion, or about 20 percent of GDP.
The sooner a national dialogue begins about end-of-life care, the better choices patients, their loved ones and physicians will be able to make about one of the most emotional periods in a human being's life.
Murray Sabrin is professor of finance at Ramapo College. He was the Libertarian Party nominee for governor in 1997 and a Republican candidate for the U.S. Senate in 2000 and 2008. Check www.MurraySabrin.com for more of his writings.
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