Thursday, September 10, 2009

Medicare End of Life Care Part 1

Lost in the rhetoric about "death panels" and "We're not going to pull the plug on Grandma" in health care reform there is a real issue that we are going to need to come to terms with and that is we can no longer afford to pay for end of life care as we are now doing. End of life care can be defined as those treatments and costs associated with the last year of an individuals life. Because most end of life care is provided through Medicare for the elderly I want to talk first a little bit about our current Medicare dilemma.

We already have a form of socialized medicine in the United States and that is Medicare. Medicare is a public plan in which the Federal government is in effect the single payor. Medicare pays for treatment for all individuals over 65 as well as paying for the disabled and those on renal dialysis. There are approximately 45 million people now covered by Medicare. Our current dilemma is that Medicare is running out of money. This is one of the reasons I have been opposed to a "public plan" option in health care reform. We are in dire straits to pay for those already on the public Medicare plan. We simply can't afford to add the estimated additional 45 million people that would be covered under such a plan.

So what is our situation now? The Medicare Board of Trustees in it's 2009 annual report indicate "The projected long term costs are not sustainable under current program parameters". "Medicare's financial situation is much worse (than Social Security)". The report indicates that by 2012 the projected assets of the Hospital Insurance Fund will drop below annual expenditures and that by 2017 the resources will be "exhausted". In just eight more years Medicare will be out of money completely. The report indicates that it will take 75 more years to bring Medicare back in balance but that is only if there is "immediate" change by increasing payroll taxes by 134% from what is now 2.9% to 6.78% or by a 53% reduction in outlays or some combination of the two. I don't anticipate we will see either of these actions anytime soon as it would be political suicide for any member of Congress to propose this.

So how does this affect end of life care? I will discuss that over the next several days.

Thought for the day

Both political parties are avoiding the Medicare issue in all the discussions about health care reform.

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