I have been a speaking fool (don’t agree so fast!) for the last week and a half, and have not had a chance to post on last week’s astonishing Newsweek cover story: “The Case for Killing Granny.” (I will bet the POTUS was not please with this cover!)
Evan Thomas, one of the dying newsweekly’s most notable writers pushes the meme that the elderly should have their health care rationed. From the article:
The idea that we might ration health care to seniors (or anyone else) is political anathema. Politicians do not dare breathe the R word, lest they be accusedhowever wronglyof trying to pull the plug on Grandma. But the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate. Everyone sees it but no one wants to talk about it.
But that is precisely what health care rationing to the elderly would be—pulling the plug on Grandma. And it wouldn’t stop there. People with disabilities may be far more costly to treat, since they live longer than the frail elderly. Once you decide that saving money is the primary goal, those who need help the most will be the ones denied it—ironically, in the cause of expanding access to care
Still, the story does not at all match the cover’s hysterics. Thomas has some good suggestions in his article that are not rationing, for example, allowing nurse practitioners to be more involved in a “gate keeper” role between very sick patients and the costlier consultation with a physician:
Physicians at Massachusetts General Hospital are experimenting with innovative approaches to care for their most ill patients without necessarily sending them to the doctor. Three years ago, Massachusetts enacted universal carejust as Congress and the Obama administration are attempting to do now. The state quickly found it could not afford to meet everyone’s health-care demands, so it’s scrambling for solutions. The Mass General program assigned nurses to the hospital’s 2,600 sickestand costliestMedicare patients. These nurses provide basic care, making sure the patients take their medications and so forth, and act as gatekeepersthey decide if a visit to the doctor is really necessary. It’s not a perfect systempeople will still demand to see their doctors when it’s unnecessarybut the Mass General program cut costs by 5 percent while providing the elderly what they want and need most: caring human contact.
Thomas also pushes hospice, which I support too—as long as it is not coerced. But changes are needed in the regulations around hospice, for example, explicitly stating that tube feeding is permitted. Today, some hospices refuse to accept patients receiving ANH in the fear that it will be deemed life-extending treatment for which they will not be paid by Medicare. That limitation, in turn, prevents some patients—who don’t want to dehydrate to death—from agreeing to the palliative approach.
Thomas’s article mostly dealth with alternatives to rationing boards and thus deserved a more substantive headline than “The Case for Killing Granny.” But Newsweek is desperate for readers, and so—ignoring their own criticisms of Sarah Palin for being alarmist with her “death panel” charge—the editors threw caution to the wind.