Rational Discussion, or Discussion about Rationing?

In a recent post on the Health Beat blog, Naomi Freundlich comments that although life-expectancy is increasing, so is the incidence of multiple medical problems and chronic disease in the elderly. Which, once again, raises the question of how Medicare costs could possibly be tamed?

The author goes on to say that "we also face a more personal, moral challenge as life expectancy continues its relentless march forward: We must begin to separate new treatments that will help older people age better—avoiding long-term disability, dementia and frailty—from those that merely extend life at any cost. We can only do this by having honest conversations about end-of-life issues; in medical schools, among families and between doctors and patients. "

The Urban Institute, a nonpartisan research center, found in a 2009 report that the government could save $90.8 billion over 10 years by better managing end-of-life care. And, the Institute further concluded that much end-of-life spending isn’t sought by patients and goes against their families’ expressed preferences.

$90 BILLION dollars. Makes me wonder who would be receiving that money if it were spent. Surely, much of it would go to hospitals. And some of it to physicians. Makes me wonder also if this subject can be discussed rationally, rather than it being a discussion about rationing.