ProPublica – Co-published with The
Washington Post
Originally published February 28, 2013
Here are some excerpts:
I've long observed, and sometimes
chronicled, the nasty policy battles surrounding end-of-life care. And like
many health journalists, I rolled my eyes when I heard the phrase
"death panels" used to describe a 2009 congressional
proposal that would have allowed Medicare to reimburse physicians who provided
counseling to patients about living wills and advance directives. The frenzy,
whipped up by conservative politicians and talk show hosts, forced the authors
of the Affordable Care Act to strip out that provision before the bill became
law.
Politics aside, I've always thought
that the high cost of end-of-life care is an issue worthy of discussion. About
a quarter of Medicare payments are spent in the last year of life, according to recent
estimates. And the degree of care provided to patients in that last
year — how many doctors they see, the number of intensive-care hospitalizations
— varies dramatically across states and even within states, according to the authoritative Dartmouth
Atlas.
Studies show that this care is often
futile. It doesn't always prolong lives, and it doesn't always reflect what
patients want.
In an article I wrote for the Los
Angeles Times in 2005, I quoted a doctor saying: "There's
always one more treatment, there's always one more, 'Why don't we try that?'
... But we have to realize what the goals of that patient are, which is not to
be in an intensive-care unit attached to tubes with no chance of really recovering."
