How to save Medicare now: Start talking about how much we spend on end-of-life care

Al SharRecently the Wall Street Journal carried an article headlined “Proton-Beam Treatment for Prostate Tumors No Better Than Radiation” referring to a paper published in the Journal of the National Cancer Institute.

Actually the results indicate that while they could see no long term benefit, there was a short term incidence of problems with urinary function. So there is a benefit and the real issue is that the cost of the treatment is hugely more than radiation. If the costs were comparable, the headline would be different. In an earlier article the WSJ reported that “Medicare patients rack up disproportionate costs in the final year of life. In 2009, 6.6% of the people who received hospital care died. Those 1.6 million people accounted for 22.3% of total hospital expenditures.” Of course, it’s difficult, if not impossible, to determine before the start of treatment, exactly who will die.

It is pretty clear that many of the issues are economic, not clinical. The reality is that people are living longer and that, no matter how much you can drive down the cost of treatment, the longer you live, the more service you’ll use. It’s also the cost that new medical technologies help people live longer, exacerbating the problem. If that’s the case perhaps we should adopt the practice of Senilicide (the killing of old people) in a manner similar to that which was reportedly practiced by some of the Inuit. That would be one way of dealing with Medicare financing.

Perhaps a slightly less repugnant way is to stop covering medical services when someone reaches a certain age. Of course that’s inhumane. The point is that, as long as we pretend that it’s not a care – and – cost issue, the less we’ll be able to deal with the realities.


We’re not going to, nor should we try, and stop science from finding new and sometimes expensive new interventions. While science may find some expensive treatments unnecessary and some low cost innovations may be shown to be effective, I don’t believe that can sufficiently offset the costs of new discoveries and the fact that people are living longer. I know that there are those who cite the lower cost of care elsewhere. That’s a function of perception, culture and psychology and is difficult to change. There are others who are focused on healthy behavior, health maintenance and disease avoidance. That’s a function of habit and lifestyle and will take longer. We need to think about what we can do now.

The facts are that people are living longer, staying younger longer and, when older, stay sick longer. It seems to me that keeping the retirement age at 65, or even below 70, is unrealistic and impractical. Synchronizing Medicare eligibility with this work reality doesn’t seem radical. The recent resurrection of the controversy about raising eligibility age to 67 as part of deficit reduction seems to me more associated with managing who would pay than any reality.

Raising the retirement age and the associated governmental benefit programs for those healthy enough to work makes sense on a number of fronts. It helps the government’s entitlement programs, it deals with looming broader fiscal problems and it helps keep productive people being productive longer.

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