The Ambassador of Death

Suddenly end-of-life care is back in vogue.

Here’s the New York Times explaining why: 

In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.

The findings, published online Wednesday by The New England Journal of Medicine, confirmed what palliative care specialists had long suspected. The study also, experts said, cast doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.

 

“It shows that palliative care is the opposite of all that rhetoric about ‘death panels,’ ” said Dr. Diane E. Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine and co-author of an editorial in the journal accompanying the study. “It’s not about killing Granny; it’s about keeping Granny alive as long as possible — with the best quality of life.”

 
Here’s what the study found and what the New York Times conveniently ignores: People with end stage lung cancer who were given palliative care at diagnosis and  simultaneously with standard cancer care  “had a significantly better quality of life and significantly lower rates of depression than those who received only standard care.

They also lived longer — median survival for patients in the simultaneous-care group was 11.6 months and in the standard-care group was 8.9 months (P = .02). This survival benefit of 2.7 months is similar to that achieved with standard chemotherapy regimens.”  (www.nejm.org)

The New York Times  reporting makes it seem that palliative care alone was better and that it was therefore wrong to eliminate end of life counseling from Obamacare by calling it a death panel.

In fact, end of life counseling in the original version of Obamacare was not about  “keeping Granny alive longer” or even palliative care.

 

Section 1233 of the health-care bill drafted would have paid doctors to give Medicare patients end-of-life counseling “every five years -- or sooner if the patient gets a terminal diagnosis.” 

 

And the counseling was to include advanced care planning, including key questions and considerations, important steps, and suggested people to talk to about” living wills and durable powers of attorney, and their uses …a list of national and State-specific resources to assist consumers and their families."   Not a word about living longer. To suggest now that’s what Democrats meant is absurd: If spending more money to let Granny live longer after a terminal diagnosis  why keep reminding people every five years about “living wills”?

Because it’s a way of telling seniors as they get older that living longer is not very valuable.  Here’s Victor Fuchs, an Obamacare advocate, economist and long time consultant to Donald Berwick and Obama’s health policy adviser Ezekiel Emanuel on technologies that extend life:

 

“..further gains in life expectancy will mostly mean keeping more Americans alive while they are retired and dependent on indirect transfers of funds from younger workers for much of their living expenses, health care, and social services.”   Because keeping people alive longer is so…wasteful Fuchs suggests government discourage “ innovations that increase life expectancy”  in favor of innovations, such as joint replacement, that improve the quality of life for both the elderly and the near-elderly.”

 

This is ideology masquerading as science.  In fact, advances that improve quality of life also tend to improve survival especially when it comes to diseases associated with aging.  And it winds up reducing or slowing the cost of treatment.   Since 1996, the average per patient costs for cancer, heart disease and mental illness have declined in inflation adjusted dollars.  And life expectancy continues to increase as well. 

 

But that’s not good enough for Fuchs,Berwick and others.   And just because of end of life counseling is gone, Obamacare has other tools to shorten life.  One way to do it is to have the government not pay for any new technology that doesn’t meet this goal.  Another is to not count spending on such innovations when determining if a health plan spent the federally required 80-85 percent of it’s premiums on medical care.   Still another is paying doctors to discourage people from using new technologies by discussing their risks and lack of value.   

 

Fuchs states: Obamacare should only pay for   “innovations whose main effect is to substantially decrease cost while holding quality constant or reducing it only slightly.”   Many Obamacare advocates endorse his view with enthusiasm.  Yet by that standard, a combination of palliative and standard care that increases well-being and extends lives would be discouraged by government.   Maybe the term “death panel” understates the problem.