Provision for End-of-Life Care Losing Support

Janet Adamy, of the Wall Street Journal, wrote that a controversial section of the health care reform bill is losing favorability in an article yesterday.  The provision, as it stands right now in the House bill, states that Medicare would provide end-of-life counseling to patients once every 5 years.  Even though the consultation is optional, the public isn’t going for it.

During the proposed sessions with patients, doctors could discuss matters such as living wills or getting hospice care.  This part of the bill adds about $3 billion to the cost of health care overhaul over the next 10 years.  Proponents of the provision claim that in the long run, money will be saved by reducing end-of-life care that patients do not want. 

Critics of the provision claim that health care rationing would occur under these conditions.  A bipartisan group composed of three democrats and three republicans in the Senate Finance Committee are working through a bill that excludes the provision.  As of yesterday, however, it is still in the House bill. 

Iowa Senator Charles Grassley was quoted in the article saying, “You shouldn’t have counseling at the end of life.  You ought to have counseling 20 years before you’re going to die.” Many people are concerned with how end-of-life care is often discussed in conjunction with cost savings. 

According to a 2001 study published in Health Affairs, 5% of people on Medicare die every year while about 28% of total Medicare spending comes during the last year of life.  Meanwhile, the Urban Institute estimated that the government could save about $91 billion over 10 years by better managing end-of-life care.  The nonpartisan research center says that there are two ways to save money with Medicare: by discouraging doctors from providing care just because they would get paid for it and having teams at hospitals assisting people to manage their pain who decide to stop treatment.

Robert Berenson, a former Medicare official in the Clinton administration and a fellow at the Urban Institute, was quoted in the article saying, “People are getting overtreated at the end of life.  This would save money and improve the fidelity to people’s wishes.”

However, according to Adamy, reducing overtreatment is not easy.  It is difficult for doctors to tell whether a patient is near death and most patients want to avoid death at all costs.

Question: What do you think about this provision?

To read the entire Wall Street Journal Article, click here: End-of-Life Provision Loses Favor