Let’s all talk about death

End-of-life healthcare is expensive. The top 5% of end-of-life patients incur nearly half of the nation’s healthcare costs. So one of the objections some Americans raise to the idea of universal healthcare, is that we simply can’t afford to offer everyone that kind of care. The assumption is that if everyone has healthcare, everyone will want to be kept alive as long as possible.

Except that’s not true. It turns out that if you actually ask people what they would like in terms of end-of-life care before they are unconscious on a drip feed or in a coma, they say that no, they don’t want to be kept alive if they’re in a coma, they don’t want chemotherapy if it’s only going to keep them alive for another 3 months and will make them feel miserable, they don’t want an extra 6 months of life confined to bed and attached to tubing and machinery.

What’s more, research shows that people who have less spent on their care during the last few months of their life have a better quality of death. Basically, beyond a certain point, you can keep people alive, but you keep them alive in constant misery.

The problem is, you have to get people to indicate their wishes before they get to that point. Otherwise, relatives who are forced to make the decisions will err on the side of keeping the patient alive at all costs, and medical professionals will quietly go along with that, because no doctor or nurse wants to try and talk someone into letting their relative die.

In fact, it’s best to get people to indicate their wishes before they are terminally ill at all, because otherwise it’s a really horrible conversation for everyone involved. And that means that mostly, it doesn’t happen.

But in La Crosse Wisconsin, 96% of people who reach the end of their lives are found to have set out specific directions regarding their end-of-life care and their death; an amazingly high number. NPR Planet Money has the story of how that happened, but the end result is that La Crosse has sharply reduced end-of-life healthcare costs—$18,000 for the last 2 years of life, compared to $26,000 national average, or $75,000 for New York.

So, if we could persuade people to record their actual preferences for end-of-life treatment beforehand, we could give them all the medical care they wanted, and save money, and make the experience far better for everyone. The process would involve each person having a conversation with a doctor, answering some questions about their wishes, and having the resulting document legally witnessed. Simple enough, so why isn’t that being done?

Well, as NPR explains, an attempt was made to provide a financial incentive for people to engage in that kind of end-of-life planning. The Washington Post explains what happened next, thanks to Sarah Palin:

[Palin’s] first post was about a proposal in the emerging bill that would allow Medicare to pay for doctor’s appointments for patients to discuss living wills and other end-of-life issues. Palin’s decision to call this pending provision a “death panel” ignited a firestorm that resulted in the language being removed from the final legislation.

So the Affordable Care Act was supposed to pay for everyone to have a session where they sat down with a doctor and discussed various possible situations they might end up in at the end of their life, and what treatment they would like in those hypothetical situations. It wasn’t a meeting for them to justify why they deserved to live; it was so that they could express their (free choice) judgement regarding what situations are worth living through.

Thanks to Sarah Palin, the idea of paying for people to go through that process died. But if you’ve read this far, perhaps you’ll consider doing it anyway.

Sticker shock

It’s health insurance enrollment time again. I’m enrolling us, because let’s face it, I hate freedom. I’ve been watching the news, and I therefore know that Obamacare is a vile plot to make wealthy people pay a lot more for healthcare so that the undeserving poor can shirk their duty to die quietly of treatable ailments.

We’re not part of the 1% — not by a long shot — but I think we’re in the 20%, if that’s a thing, so apparently it’s up to us to pay for those single mothers. Over the last few months I had read that the middle class were going to get squeezed, because we would not qualify for any kind of subsidy because we make more than 4x the federal poverty level. Yes, people with pre-existing conditions on group plans would definitely lose out, getting less coverage and having higher costs. But how much higher?

The predictions were pretty dire — premiums were said to be going up by an average of 26% in Texas. Or maybe 37%, for middle aged people. Yes, 37% for middle aged men. Or maybe 88%, for middle aged men with pre-existing conditions opting for bronze-level or equivalent coverage in Texas. In fact, according to the experts at the Heritage Foundation, I could expect a robust 91% increase in insurance premiums.

So obviously, it was with trepidation that I read about the options available to me. Perhaps I would have to stop paying for the best available plan with the ultra low deductibles? I clicked through and saw the final cost. It has gone up by a massive, punitive 10% compared to 2012.

Obviously I am shocked, shocked to find out that so many dire predictions made by right-wing think tanks appear not to be accurate.

Hospital imitates Monty Python sketch

There’s a story in the news about a woman who dropped dead in the waiting room of a hospital. She slid off the chair and ended up face down in the corner of the room. Nobody else in the room did anything. It was 45 minutes until another patient drew attention to the corpse. There’s video.

Maybe I’m fooling myself, but I’d like to think I’d have at least called out "Hey, you in the corner, face down on the floor, are you OK?"  And maybe if there hadn’t been a response I’d have, oh, perhaps got off my ass for a couple of minutes and found someone appropriate to inform about the situation.

Then again, it was the psych ward. Maybe things work differently there.

Google Health has launched

From the contract you have to agree to:

When you provide your information through Google Health, you give Google a license to use and distribute it in connection with Google Health and other Google services. However, Google may only use health information you provide as permitted by the Google Health Privacy Policy, your Sharing Authorization, and applicable law. Google is not a "covered entity" under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder ("HIPAA"). As a result, HIPAA does not apply to the transmission of health information by Google to any third party.

And it’s still solving the wrong problem.