Need to shut down comparative effectiveness now.
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.
The New York Times skews the study to make it
seem that palliative care was used instead of actual treatment of
the disease 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.”
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 was the goal, 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 end of life counseling is gone, Obamacare has
other tools to shorten life. Hospice care is being cut under
Medicare. Another way to shorten life is to have the
government not pay for any new technology that doesn’t meet this
goal. Still another is not to count spending on such innovations
when determining if a health plan spent the federally required
80-85 percent of its premiums on medical care.
Steering people to use fewer life-extending innovations
based on what the government thinks is valuable is the defining
function of Obamacare. As Fuchs states: the government should only
pay for “innovations whose main effect is to substantially decrease
cost while holding quality constant or reducing it only slightly.”
The combination of palliative and standard care for end stage lung
cancer patients would not meet that government set
criterion.
Reduce quality and discourage people from living longer?
Maybe the term “Death Panels” isn’t so inaccurate after
all.
