Growing Costs at the End of Life

This week, the Bipartisan Policy Center published, “What is Driving U.S. Health Care Spending,” a report that details the main drivers of health care cost growth. This paper is part of BPC’s Health Care Cost Containment Initiative, which Senator Bill Frist heads alongside Democrat Senator Tom Daschle.  The program is taking a close look at the areas of our health care system producing unsustainable cost growth, and what can be done to reign in those costs.

Of these main drivers of cost, one stands out.  Health care spending at the end of life accounts for a large portion of the program’s overall spending. In 2006, Medicare spent $38,975 on patients in their last year of life, roughly one quarter of the program’s spending. Each year more people are turning 65 than had the prior year, a testament of our aging “Baby Boomer” population.  It’s not difficult to see why this is a problem.  If you haven’t heard, humans are mortal.  All of us die.  So with an increase in those turning 65 this year, that means that that there will be an increase in those dying in future years.  With an inevitable and growing multiplier (deaths), in order to slow cost increases Medicare must find a way to decrease the approximately $40,000 it spends on decedents in their last year of life.

Admittedly, that is an oversimplification of the issue at hand.  We are after all talking about human life, that which we treat as a miracle at birth and cling to at death.  It is no wonder that a major portion of costs come in the last months of a patient’s life. They are by definition the sickest at this time, and death is hard. No matter the age, saying goodbye to a loved one is not easy.  But what is even more difficult is seeing a loved-one suffer at death, and often times the costly treatments administered at the end of a patient’s life create suffering.  In order to decrease costs, doctors, patients and their families must engage in a difficult but necessary discussion when it is time to stop fighting the disease and ensure that the patient is cared for, without pain. This conversation will inform doctors and the patients’ families of their preferences in the last days, weeks, or months of their lives.

In addition to initiating important conversation to make doctors and families aware of patient preferences, we must alter the political landscape in order to create any real change.  Senator Frist is calling for bipartisan commitment to reduce end-of-life healthcare spending.  For too long, political exaggerations of ideas to reduce the costs have stalled action.  Rhetoric has overshadowed reality. Evaluating and reducing excess and unnecessary costs in end-of-life care is not “pulling the plug on grandma.”  A group of experts assessing the most cost-effective treatments is not a “death panel.” And rationing is not an evil idea, but a necessity for reducing healthcare costs.   As soon as we approach this issue realistically, from both sides of the isle, we will be able to reduce costs while simultaneously taking better care of our loved ones as they approach death.