Commentary By Ron Beasley
How dysfunctional is the the US health care system? We have lotteries to decide who lives and dies.
Oregon will draw names to expand health plan
Oregon is gearing up to open the state health insurance plan next month
to cover an additional 35,000 uninsured adults who have low incomes and
good luck.Health officials estimate that about four times
that many adults qualify for the Oregon Health Plan, so they will take
names and hold periodic lotteries to add winners to the plan over the
next 20 months.
Even if you "win" the lottery your problems are not solved. You still have to find a doctor who will accept the really poor reimbursement the Oregon Health Plan offers.
I had an "epiphany" last night while watching health-care reform discussed on MSNBC last night. One possible cost-cutting move. . .
ReplyDeleteEnd-of-life care consumes a disproportionate amount of health-care costs. Still, people die broke, in pain, and lonely. Why not give us the option of foregoing long, dranwn-out, expensive end-of-life care and instead be guaranteed the best hospice (cheap in comparison) care possible?
You'll be pain-free, get your hand held, and may even still have money left over for your heirs!
I know -- it sounds too much like a death panel to work.
When my mother was diagnosed with inoperable metastatic lung cancer last December at the age of 92 I knew immediately that when she was discharged to return to the nursing home she would be on hospice. To my great surprise I learned that not only does Medicare pay $4000 toward hospice care, but there are dozens of hospice services from which to choose! It's already a business, and the place where my mother was being cared for regularly deals with five such services.
ReplyDeleteFor the last seven years now I have been working in the "retirement" environment, which is to say that population most likely to be hospice candidates. My observation is that many, if not most people remain in denial about death, either theirs or that of their loved one, to the point that end of life suffering and expenses are protracted way past the time when it should have ended.
It is not necessary that so many die, as you said, broke, in pain, and lonely. In fact, many do not, but too many do, thanks to modern science. A morbid joke I came across last year was "Q. Why do coffins have nails? A. To keep out the oncologists."
The "broke" part comes long before the end of life. Medicare has pretty good benefits but to qualify for Medicaid (another word for welfare) one must first become officially destitute. It's called "spending down." The "in pain" part, thanks to hospice, is minimal. And the "lonely" part is the tragic consequence of abandonment for any number of reasons. Thankfully, most hospice providers offer as much ersatz sympathy as professional competence can offer without burning out paid caregivers. Even in the nursing home environment I saw evidence of real grieving among the staff at the loss of a resident, even one receiving hospice care.