What Medicare Services to Cut, Now

[okarol]

Updated June 2, 2011 06:46 PM
What Medicare Services to Cut, Now
Introduction

© Marilyn Barbone/Dreamstime.com

The Obama administration is trying to make changes to slow the growth of Medicare, but without provoking the public outcry that met the sweeping Republican plan earlier this year.

For example, officials say Medicare will soon track spending on millions of individual beneficiaries, and reward hospitals that hold down costs and penalize those whose patients prove most expensive.

What items and procedures should Medicare stop paying for now, even if patients and their families object?

Discussion: http://www.nytimes.com/roomfordebate/2011/06/01/what-medicare-services-to-cut-starting-today

Comment: Stop Aggressive Therapies

June 1, 2011
Cheryl Woodson has taught and practiced geriatric medicine for 30 years, spending 10 of those years also caring for a parent with Alzheimer's disease. She is the author of "To Survive Caregiving: A Daughter's Experience, A Doctor's Advice."

I think Medicare (and all other health insurance providers) should stop paying for CPR, dialysis and other aggressive therapies when patients have no chance for cure or recovering function.

Death is not optional: When we insist on assaulting people with futile technology, we prolong their dying.
C.P.R. is not the treatment for terminal cancer, heart failure or other chronic illnesses. Dialysis won't change the course for someone who is dying of lung failure, and feeding tubes won't cure dementia.This is not just about aging; we will have to make these difficult decisions on 25-week-old babies as well.

Death is not optional. When we insist on assaulting people with futile technology, we not only fail to prolong their lives; we actually prolong their dying. Hospice is a wonderful alternative to this assault; it allows us keep people comfortable and love them ... to death.

[lmunchkin]

As painful as it is to say this, but this individual is telling the truth!  With the nation in debt up to its eyeballs, I do believe that those living on Life Support, unfortunately, will be the first to go!  Unless they have the finances to continue!

It is no secret to alot of you that when my husband was diagnosed in 2004 with ESRD he did not want Dialysis for his life!  I was the one to choose Dialysis for him.  Did I make the right decision in prolonging his death? God knows my Love was for my husband,but was it the right thing to do?  Time will tell!

lmunchkin   

P.S. This is not a Democrat/Republican issue!  It is an issue that affects us all!!!

[willowtreewren]

It is important to have clearly stated medical directives and medical power-of-attorney arranged for the possibility that you will not be able to make decisions regarding aggressive life sustaining procedures. Don't wait. And be vocal with your loved ones about your wishes.

Aleta

[tyefly]

     "no chance for cure or recovering function. "      What with this statement.... recovering function... with dialsysis....  and no chance for cure.....   sounds like if dialysis doesnt recover kidney function then we shouldnt do it....        sounds like death camps to me.....

[lmunchkin]

Hey Aleta!  Yea we have all of that now.  In so doing, it did make things clearer for me. But it is still painful nonetheless. It just one of those things that I have to leave in God's hands, you know what I mean? Just live each day together, until we die. Sounds cruel, but it is painfully true!

How is Carl doing?  Yall been anywhere lately?


lmunchkin   

[Jie]

Extending this logic a little bit: everyone is going to die someday, and no medicines and procedures can prevent people from dieing, so it is cheaper to stop medical treatments to everyone. This does not make any sense. Dialysis, like other treatments, is a way to extend the life. I think the issue is not to stop dialysis completely, rather, at what point, we should stop dialysis. Not every dialysis patient is the same.

[Bill Peckham]

Unfortunately end of life care can't be discussed by the US political process, and Medicare operates through the US political process.

[lmunchkin]

Yea, I sorta understand your logic, Jie.  But the topic is about Medicare cuts and how dialysis (Life Support) may be the first to go, except for those who can financially afford this very expensive form of Life Support. This country is in Debt and someone is going to have to make sacrifices.  The first place to look is to those with chronic illnesses that there is no cure for, ESRD, Terminal cancer ect......

If they take your Dialysis away cause you cant afford it, then what happens?  It's sad, but it is coming!!!  And what a sad day it will be! It means that my husband will not have a choice, this country will decide it for him!  I dont like that, but what can I do if it comes to this?  I really can't answer those questions! But this I do know, I don't want him to go nor anyone suffering this dreadful disease! That is the Truth!!

I've come to know and love alot of people on this site, but ultimately, we will all die, and we know that for sure! It is our destiny!

lmunchkin     

[MooseMom]

No one is talking about taking away dialysis from those patients who truly benefit from it.  This article, along with others that accompany this debate, talks about ending dialysis or not even starting it on those patients who have so many co-morbidities that dialysis is not life-saving but is, rather, death-prolonging.  Dialysis can be torture for those who are elderly or suffering from dementia on top of other conditions that have led to renal failure.  This is why it is called the "art" of medicine; doctors have to judge whether or not such an invasive treatment like dialysis causes more harm than good for a particular patient. 

And Bill is right...it does seem that our political system is such that we can't have a reasonable discussion about end of life care without people starting to yell about government interference or "death panels".  But we all understand that there are times where the more merciful course of action is hospice as opposed to, say, the initiation of dialysis.  We don't give enough attention to pallitive care and hospice, and that's a great shame.

My mother was on dialysis for 5 years.  It kept her alive and in reasonably good shape, and she had a decent quality of life.  But when she got a blood infection and was dying of sepsis, keeping her on dialysis just seemed cruel.  She died, though, before it became a big issue.

[PatDowns]

This following excerpt on living wills is from Charles Krauthammer's essay, "The Truth About Death Counseling."

"...consider the actual efficacy of a living will. When you are old, infirm and lying in the ICU with pseudomonas pneumonia and deciding whether to (a) go through the long antibiotic treatment or (b) allow what used to be called “the old man's friend” to take you away, the doctor will ask you at that time what you want for yourself — no matter what piece of paper you signed five years ago.

You are told constantly how very important it is to write your living will years in advance. But the relevant question is what you desire at the end — when facing death — not what you felt sometime in the past when you were hale and hearty, sitting in your lawyer's office barely able to contemplate a life of pain and diminishment.

Well, as pain and diminishment enter your life as you age, your calculations change and your tolerance for suffering increases. In the ICU, you might have a new way of looking at things.

My own living will, which I have always considered more a literary than legal document, basically says: “I've had some good innings, thank you. If I have anything so much as a hangnail, pull the plug.” I've never taken it terribly seriously because unless I'm comatose or demented, they're going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. The paper I signed years ago will mean nothing.

And if I'm totally out of it, my family will decide, with little or no reference to my living will. Why? I'll give you an example. When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father's wishes: What he checked off on a form one fine summer's day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious.

Except for the demented orphan, the living will is quite beside the point. The one time it really is essential is if you think your fractious family will be only too happy to hasten your demise to get your money. That's what the law is good at — protecting you from murder and theft. But that is a far cry from assuring a peaceful and willed death, which is what most people imagine living wills are about..."

Full commentary can be read here:  http://www.chron.com/disp/story.mpl/editorial/outlook/6583451.html

For those of you unfamiliar with Krauthammer, he has been a columnist with the Washington Post since 1985,  and received the Pulitzer Prize for Commentary in 1987.  He began his journalism career at The New Republic, where he was a writer and editor and won the 1984 National Magazine Award for Essays and Criticism.  Before going into journalism, he was a speechwriter for Vice President Walter Mondale during the 1980 presidential campaign, directed planning in psychiatric research for the Carter administration, and practiced medicine for three years as a resident and then chief resident in psychiatry at Massachusetts General Hospital.  Krauthammer had a diving accident during his first year at Harvard Medical School in the early 1970s which left him paralyzed for life.

It is important to have clearly stated medical directives and medical power-of-attorney arranged for the possibility that you will not be able to make decisions regarding aggressive life sustaining procedures. Don't wait. And be vocal with your loved ones about your wishes.

Aleta

[Bill Peckham]

I don't think this is helpful. Obviously if you're alert you can direct your care. Everyone should understand that if you're in an ER, talking to the docs the advanced directive does not come into play. And it is true that if you are unable to provide consent your family can decide to ignore your advanced directives because they believe your thinking has changed over time but so what?  The guidance to have an AD is so that if you are unable to give consent the person or person(s) that can give consent for you have an idea what it is you'd want done.


One of the key steps when putting together your AD is that you talk to your loved ones so they know something about your thoughts and feelings about invasive medical care at the end of your life. This is an issue because so many people get caught up in a medical system with the default of doing everything anyone will pay for and Medicare will pay for a lot of things many (most?) people wouldn't want to have happen.


If everyone was an old doctor with an attentive family, maybe this would be less of an issue and we could rely on ones survivors to make decisions but long experience has shown time and time again that without any sort of advance planning fates worse than death are set in motion every day.

This following excerpt on living wills is from Charles Krauthammer's essay, "The Truth About Death Counseling."

"...consider the actual efficacy of a living will. When you are old, infirm and lying in the ICU with pseudomonas pneumonia and deciding whether to (a) go through the long antibiotic treatment or (b) allow what used to be called “the old man's friend” to take you away, the doctor will ask you at that time what you want for yourself — no matter what piece of paper you signed five years ago.

You are told constantly how very important it is to write your living will years in advance. But the relevant question is what you desire at the end — when facing death — not what you felt sometime in the past when you were hale and hearty, sitting in your lawyer's office barely able to contemplate a life of pain and diminishment.

Well, as pain and diminishment enter your life as you age, your calculations change and your tolerance for suffering increases. In the ICU, you might have a new way of looking at things.

My own living will, which I have always considered more a literary than legal document, basically says: “I've had some good innings, thank you. If I have anything so much as a hangnail, pull the plug.” I've never taken it terribly seriously because unless I'm comatose or demented, they're going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. The paper I signed years ago will mean nothing.

And if I'm totally out of it, my family will decide, with little or no reference to my living will. Why? I'll give you an example. When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father's wishes: What he checked off on a form one fine summer's day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious.

Except for the demented orphan, the living will is quite beside the point. The one time it really is essential is if you think your fractious family will be only too happy to hasten your demise to get your money. That's what the law is good at — protecting you from murder and theft. But that is a far cry from assuring a peaceful and willed death, which is what most people imagine living wills are about..."

Full commentary can be read here:  http://www.chron.com/disp/story.mpl/editorial/outlook/6583451.html

For those of you unfamiliar with Krauthammer, he has been a columnist with the Washington Post since 1985,  and received the Pulitzer Prize for Commentary in 1987.  He began his journalism career at The New Republic, where he was a writer and editor and won the 1984 National Magazine Award for Essays and Criticism.  Before going into journalism, he was a speechwriter for Vice President Walter Mondale during the 1980 presidential campaign, directed planning in psychiatric research for the Carter administration, and practiced medicine for three years as a resident and then chief resident in psychiatry at Massachusetts General Hospital.  Krauthammer had a diving accident during his first year at Harvard Medical School in the early 1970s which left him paralyzed for life.

It is important to have clearly stated medical directives and medical power-of-attorney arranged for the possibility that you will not be able to make decisions regarding aggressive life sustaining procedures. Don't wait. And be vocal with your loved ones about your wishes.

Aleta

[noahvale]

*

[Rerun]

I have always thought the same as the author.  When people don't even know their name and they are put on dialysis just because they have a pulse and the Dialysis Center gets a check from Medicare for this lost soul, it is wrong.

Also, at $36,000 a month (submitted charges) for the dialysis process.  Only Bill Gates will remain on dialysis.

Come on!  Cut the costs to what it "really costs" and let the private insurance take over.

Leave Medicare for whom it was intended for. Those over 65.  AND yes if you are over 65 (and know who you are) you would be sitting by Bill Gates on dialysis, with Medicare paying.