The Curve-Benders’ End-of-Life Obsession: Buried in the now-famous May, 2010 David Cutler memo–warning the White House that their Obamacare launch team was “not up to the task”–is this complaint:
“I recently met with the senior CMS staff about how all the new demonstration and pilot programs envisioned in the legislation might work. This is a crucial issue because the current demonstration process takes about 7 to 10 years, and thus following this path would lead to no serious cost containment for the next decade. When engaged about the speed of reform,the staff expressed the view that: (a) their fear was going too fast instead of going too slow; (b)we ought to add a layer of university review to the existing process, to be sure we are doing the right thing; and (c) the natural place to start demonstrations is in end-of-life care (Death Panels notwithstanding).”[E.A.]
Remember back in 2009 when President Obama told David Leonhardt about the need for a “difficult democratic conversation” about “end-of-life care” in order to rein in health care costs? Oh, no, we were told. He didn’t really mean to focus on denying treatments to the elderly (even though he’d used his own grandmother’s hip operation as an example). The big savings aren’t from pulling the plug on Granny anyway (or sending her to a hospice)! They’re from “less costly care in complex cases.” They’re from avoidance of expensive name-brand drugs (red pill/blue pill) and ineffective, untested treatments for the non-dying. After all, even Obamacare adviser Ezekiel Emanuel didn’t think there were didn’t think there were big savings to be wrung from end-of-life care. For other experts, end of life savings were real but way down on the list of possible things to focus on.
But it turns out that in the event, the actual officials in charge of the program … well, they went right for granny. …
P.S.: I have had two parents die in the pre-Obamacare medical system in Los Angeles. I did not see a lot of unnecessary procedures or fat that could be cut. On the contrary, there was huge pressure–if anything, too much pressure- to sign advance directives and accept transfer to hospice care.