In a remarkable and frankly moving article about his wife's cancer, a health industry executive gropes for some answers to our health care delivery philosophy and the consequent economics.
So, what do we do? I wish there was an answer that offered real value. After all, I’m a business executive who runs a health plan providing benefits to thousands of employers. I’m also a taxpayer who supports government programs. Unfortunately, there are no such assurances, but there are steps we can take.It will be impossible to avoid the hard choices rushing toward us of how much health care is given to each person. Given the enormous and certainly advanced health care industry here in the US, the answer has always been "whatever it takes". But just like we are finding out the pledge to "pay any price" is an unsustainable burden when applied too loosely to every foreign policy objective, the hard truth is that we can provide more services than we can afford in an ultimately futile attempt to promote an open-ended lifespan or make right every medical problem.
As a society, we need to be honest about treatment limitations. Patients should be well informed about what the industry knows and doesn’t know. There should be candor about the likelihood that care will make them worse instead of better. Patients should be empowered to be the treatment decision makers.
In recognition of the uncertainty patients face, we need to compassionately acknowledge their pain and fear. We need to counsel that aggressive intervention isn’t always the best course of action.
I share these conclusions not to suggest dissatisfaction; Linde and I are grateful for her care. Her clinicians included the country’s most respected doctors who did what they were trained to do -- aggressively seek a cure.
Rather, these observations are offered to challenge the U.S. health-care industry to be more explicit about medical treatment being as much an art as a science and to provide emotional and spiritual support to improve patient and caregiver experience.
Course of Disease
There may be an economic benefit to this. As patients learn more about the limits of medicine, some may choose less intensive and costly care. As a nation, our health-care spending increases as patients near the end of life. [More]
I don't see much evidence that our current system allocates resources effectively. Our national statistics continue to decline compared to "abhorrent" systems that more effectively channel care to achieve the greatest total, rather than individual good. Spending more on prenatal and early childhood outcomes are examples of wiser spending than our elder-care focus.
But as the author above points out, a mix of education and market nudges - such as decreasing limits for some expensive interventions as we age - could help individuals to make better choices and our system to optimize the massive expenditures we now face.
It would be fair to reach and link this to the fictitious "death panel" claim, but regardless of your political preferences, the fact remains our private-for-for-the-young/socialist-for-the-old insurance system is careening toward insolvency as both costs and premiums soar. Somewhere, somehow, someone must say, "Enough, no more".
We can wait until it is the guy with the last policy or dollar, but maybe we could contemplate adjusting culturally to accept the economic and medical limits of reality.