Quantity or Quality?

During the national health care debate (and I hesitate calling what we had an actual debate, as opposed to shouting epithets at each other), one of the topics that briefly surfaced was end of life counseling.   There was a short-lived attempt to allocate Medicare funds to provide for comprehensive counseling on end of life issues, such as whether to continue treatments.  This devolved into the shouting over "death committees," among other untruths.  

Some health policy groups say cancer patients, as well as people with failing hearts or terminal dementia, should get better end-of-life counseling. Last year, a plan that would have let Medicare pay for doctors to talk about things like living wills was labeled "death panels" and was dropped.

This Associated Press article is an interesting report on the state of affairs with end of life treatment in the U.S.  What it says is that despite our "rational" desires to accept a terminal illness with some measure of grace, the facts show that we are not entering hospice care until way too late, and in many cases, desperately choosing very expensive experimental treatments to prolong "life."   The result can be a few more weeks, but at a horrible cost in quality of life.  A couple of sad facts:

—The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.
—Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

The denial that Americans seem to undergo (although you might choose to call it "hope") is a good part of the reason that "health care costs" are continuing to skyrocket.  If you don't have insurance, you probably don't have the opportunity to consume multiple, experimental chemotherapy treatments for terminal cancer.   If you do have insurance, you might be able to get those $10,000 treatments, but the rest of us are paying for it.

What this comes down to is a tug of war between acceptance of the inevitable versus the good old American "never give up" reliance on "hope."  It's difficult to pick one side in this debate.  Even simply leaving it up to the individual and his/her family isn't a clear solution; if they opt to continue treatments indefinitely, the individual isn't the one footing the bill, we are.

We should really try to have a rational, calm discussion in this country about quality vs. quantity when it comes to end of life treatment.  Before we truly do go bankrupt.