Wednesday, September 23, 2009

Medicare End of Life Care part 3

The views expressed in this blog are my own personal opinions and do not represent the views of Cottonwood nor it's administration.

I want to finish up on the topic of end of life care as it is an issue that needs to be faced which hasn't happened in this year's political debates on health care reform.

I will briefly recap the problem. Medicare is going broke. At current spending levels all asserts will be depleted in eight years. To save Medicare it will require a significant increase in payroll taxes as well as spending reductions. The 2009 Annual Report of the Medicare Board of Trustees indicated that payroll taxes may have to be raised to 6.78% (currently it is 2.9) and spending may have to be reduced by as much as 50%. That's a large reduction! So where are these reductions going to come from? They will come from where the money is now and that is in end of life care which currently takes 27.4% of the entire Medicare budget. 40% of that amount is spent in the last thirty days of life. The reality is that we will have to come up with some solutions that are neither "death panels" and'"We are not going to pull the plug on Grandma". At some point the plug will be pulled on Grandma and someone will be making those decisions.

I am not hopeful that we will have this debate in the public arena as we need to. It would be political suicide for a congressman or senator to bring up the idea of reducing end of life care. So I believe that we will not have this debate but that changes will come gradually with no thought or foresight.

I fear that the first change will be limitations on dialysis for end stage renal disease. Medicare pays for all dialysis regardless of age and the costs are over 6 billion dollars per year. I am concerned that we are not going to go about rethinking use of dialysis but just slowly to provide subtle encouragement for patients to voluntarily cease dialysis at some point. I don't know. I can't really say what will happen. I certainly don't have any solutions to the problem, but I do hope at some point in the near future we can have a public debate on this issue which is not going to go away by hiding from it.

Thought for the day

There is no reason we can't have that debate here. I encourage any readers to make comments or raise questions about this issue.

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