We are seeing increasing enrollments in Obamacare as acceptance of its benefits grows. With that acceptance we are learning how it can be improved, and made to function to serve us better.
Ever since the Affordable Care Act became part of the landscape, politics entered the picture. Originally the act contained a provision to pay physicians to spend time discussing end-of-life care with families because health care is a very important part of our financial life.
Immediately, it became a very emotional, and indeed, controversial issue, when it should have been understood.
The medical profession has known for a very long time that end of life care needed discussion. It is, indeed, a very difficult issue. Naturally, individuals and families have differing opinions about what to do for a patient who is very ill. On one hand, families want to keep their dear ones alive as long as possible, often with no hope of a cure. We see the suffering of the patient but often cannot face the reality of losing our loved one.
Decisions are very difficult. We want to keep the patient alive, no matter what it costs, but are we really doing what is best for the patient or, indeed for those who love them? If we were going to provide access to health care for everyone we need to make rational decisions.
Many on the side of doing everything were hysterical. They accused reasonable, humane, and thoughtful planners of wanting to create “Death Panels” to kill off the elderly and/or the hopelessly ill. Finally, that section of the bill was removed because of the furor that was created that superseded reasoned planning.
So the side who prefer to do “everything” got their way. And reason flew out the window, and with it the idea of discontinuing drastic treatment that just resulted in adding suffering. A great deal of money continued to be spent on the last few weeks of life, when alternatives were not given more attention and interest. If we really want to use money in the best way, to alleviate suffering and save the lives of seriously ill people who could actually be helped back to health, planning would have to be reconsidered.
The experience of the medical profession is that there are adverse consequences in continuing to treat aggressively when a cure is not going to come. A case in point is the example of a study published by a subsidiary of the British Medical Association of the use of a cancer chemotherapy agent used late in the course of malignancies.
Overall death rates were the same whether the very expensive drug or a placebo had been used. Patients treated with the drug, instead of simple palliative care and symptom relief, were more likely to be subjected to CPR, or placed on a ventilator or dying in an intensive care unit. What does that say about the necessity for extreme measures?
Incidentally, the drug, developed by Bayer, was intended for affluent patients, rather than for any patient. The profit motive polluted best care decisions. The British National Institute for Healthcare and Excellence does not recommend it. The American Society of Clinical Oncology agreed that this kind of decision is needed. If we were to spend our healthcare money on such studies, as part of an alternative healthcare system, called single payer, it would be well spent.
We would all benefit from a not for profit healthcare system. Let us hope that we eventually see the light and get our money’s worth.
Esther Confino
New Hyde Park
