wnyc.org / 93.9fm / am 820

@ Scott Jones -- apparently the PRICE paid for an MRI is less than in the US, but that's because they're taking a loss on it (see http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102211467.html)

Dear Ms Bacharach,

I heard you on the Brian Lehrer show on the 15th of May and I am writing to respond to your comments. Accusing physicians of deliberately keeping patients alive for financial gain struck me as a mindless, reprehensible, contemptible remark. I was personally insulted. After 45 years of practice my experience and those of my partners and colleagues do not conform with your malicious statement.
A major impact on reducing the cost of end of life care would require legislation to legalize euthanasia, somehow manage the insistence of loved ones to keep their patient alive "at all costs" and prevent malpractice suits by unscrupulous lawyers.
If your information was anecdotal and perhaps related to a personal experience, I suggest that you find another doctor.

The United States already spends 14 % of GNP on health care, the highest of all Western countries. Instead of finding solutions to the current crisis of massive fraud and corruption that is depleting resources people abdicate personal responsibility and demand more control from the government.

When Ms. Bacharach mentioned that America should follow the nationalized health care system of the Netherlands it gave me the creeps. Going in the direction of the Netherlands would mean that the government decides who gets what and who does not, who lives and who dies…….very scary!

If we're going to be fair about health care spending, we must also mention the other end of life. Couples spend absurd amounts of money conceiving babies when there are so many ready made children waiting for homes. We then save the lives of extremely premature infants who later turn out to be severely disabled. Does this make sense?

The writer who suggested it was somehow wrong to advise potent medication -- morphine or even methadone, both in use at hospices -- and preferable to perform hip surgery on Pres. Obama's grandmother misunderstood the issue.
The grandmother was within 2 weeks of dying -- doctors gave her no more than a few months. Performing hip surgery on such a patient is, in my opinion, malpractice -- as it subjects her to yet more pain, and offers no hope of an ambulatory life.
And by the way: hospice nurses are very adept at controlling pain, including fractured hip pain.

JM sad story -I am sorry for your loss.

My father, at 94, had an abdominal abcess that would be fatal if not treated. He was otherwise healthy except for vascular dementia. Our choices were that he could be "made comfortable" and allowed to die in the hospital, or that he could undergo surgery to treat the abcess. Our family (including my father) opted for surgery. In the hospital after the surgery my father had moments of lucidity, listened to music, and sang! He lived two more weeks and died in his very good nursing home surrounded by caregivers that he loved. I don't know what the surgery cost, but I believe that it was the right thing to do. If we adopt a public policy that makes treatment like this impossible for those with national health insurance, rich people will have those treatments and others will not. Is this what we really want?

It is not that there is something inherently wrong with "life saving" the expensive way - we'd all like to have the best emergency care, intensive care, surgery, etc. But do we all qualify for it at present? I don't.

More to the point, how much general care is denied because of the costs of life-sustaining care = whether for an elderly patient or a young one?

If we have $100 for care, shouldn't at least $50 be spent on keeping people healthy, discovering disease at an early, more treatable stage, preventive and reparative treatment in middle age ... and doesn't that in turn lengthen life? Why let the individual languish in his 50s-70s with uncovered ailments and complaints, then lavish care dollars when all it accomplishes is continued breathing and numbed pain?

Keep the discussion going - it's an important one.

Hello, "Truth", good question.

My mother called my father's physician to let him know that death seemed imminent, but insisted to him that he was under no circumstances to be hospitalized again. This physician (whom I obviously consider the major culprit here) called the ambulance. Once the ambulance crew were there, they insisted they had to follow their protocol.

The DNR was effective at the hospital, but apparently not something the ambulance crew cared about.

Until our medical sysytem goes National we are exposed to the competititive vulgarity of our Medicial system as a Private Industry/Profit Organization. Profit organaizations main intentions is to make profits. The profits of our Medical system are extremely high and at the expense of the individual Citizen.
Had our Medical system went National instead of issuing the these Bail-Outs our Markets would have already revived because the Employers would no longer be held responsible for Employee Medical and that would have boost all US Companies across the board.
Our Parent country England went National with their Medical system after World War II and look at the Value of the Pound it's double the US Dollar. France is also an excellent example. Our Medical system has thrown the American Dream into the pocket of Doctors and what's interesting is that the larger percetage of Doctor's in the US has changed to Emigrate East Indians which further alignates the Traditional Americian Citizens & Companies from their Americian Dreams.

My mother died a few years ago in France from ovarian cancer. For the last week of her life she was in the intensive care unit in an artificial coma waiting to see if the last surgery was successful. Then we were told that she was brain dead as something occured during the very risky surgery and that they would turn off the life support as they now had no hope to cure her, that she would never have any contact with the outside world again. This corresponded with my mother's wish to not be kept alive if she was to become completely dependant. This shows that in France, the stste doesn't keep people on life support if there is no hope to improve their condition. They believe they should use their resources to save people who have hope to live without life support. It is a policy.

JM who called the ambulance?

I think it is a mistake to couch the discussion in terms of "hope" of recovery. Hope always will exist, and it should. What's more appropriate, I think, is to talk about the *possibility* of recovery, which is a much more appropriate and objective (though, admittedly, not totally so) concept. The comments from others here about, e.g., practice in France, a fairly religious country, are very telling.

I apologize for not being clear in my other comment. I know there are very important end-of-life issues we need to discuss, but the 80% figure may include costs for treatments that wound up not working...but the part of the picture we're missing is those that worked. How do we choose where to cut off costly treatment without possibly sacrificing people like my friends who wound up surviving even though doctors wrote them off? Certainly a complex discussion worth having,

But let's also look at the other side and see where you can contain the price of treatment - including ridiculously expensive pharmaceuticals - while also looking for more efficient and effective treatments, rather than just looking at where we can cut back on treatments people receive.

I just read Judy Bachrach's article about how to choose a hospice at Obit. It's really good. I hadn't thought about a lot of the things that she explores here: http://www.obit-mag.com/viewmedia.php/prmMID/6029

This is a very timely discussion. I went through the experience of assisting my mother through terminal lung cancer 10 years ago.
When she was diagnosed, she still appeared strong and vital, with plenty of life left.
I assumed that she would opt for the full raft of treatments that the doctors were recommending, but my mother declined, because of her own healthcare experience in caring for elderly patients.
At the time I was very much against this, thinking that modern medicine would certainly do something to extend her life.
But out of respect for her wishes, the only care she received was paliative: pain primarily.
She was able to return to the home she had live in her whole life to die 'a good death' as your guest said. She was able to live another 10 months, much longer than she was given to live.
New Yorkers in this situation are lucky to live in a city where hospice care is very well practiced: the nurses of the Visiting Nurse Service of NY made this possible.

My father, at the age of 102, was dying peacefully in his sleep at home, when he was dragged off in an ambulance over my mother's objections to Mount Sinai Hospital (where he had a DNR) to die alone. Even if she had thought to say that she would not pay the bill, it would still have been covered by insurance.

Interesting isn't it hjs? They have better outcomes and they spend a fraction of what we spend.

What about the fear that doctors have of ending a life "prematurely when they could be sued by malpractice lawyers for doing so"?

I work for the ALS Center at Beth Israel and we struggle to reduce the stigma of hospice, as many patients may never fully accept their mortality, but advocacy is essential. We've had hospice agencies trying to remove some of our patients because they haven't died in 6 months, even though they probably won't live beyond 12 months. The rules are already becoming too rigid, even for patients with an always fatal disease. We cannot allow more restrictions to be placed an essential end of life service.

Seems we are only looking at the topic from our younger/healthier perspective. We rarely ask the dying how they want to die, and instead push the hospitalization process from beginning to end. My grandparents all at a certain point wanted to go home, and have a more quite last few days - yet it was hard if not impossible to leave the hospital, and they gave into that as their only option.
Of course it needs to be case to case, but let us involve the dying in the answer to the question that inevitably is theirs to answer.

yep, skirting euthanasia and when Judy approached it Brian completely put the kabash on it.

Being in pain has been mentioned several times as a reason not to prolong life. But pain control in US hospitals is often inadequate. This needs to be a major part of the discussion of this issue.

When the government pays for all health care, the government will have total control over who gets born and when, and who dies and when.

Do you really want to give the U.S. President, Congress and Supreme Court total control of abortion, contraception, fertility treatments, life-shortening pain killers at the end of life or life-lengthening treatments?

I want all of those decisions reserved to myself and my doctors, my family and any religious advisers I may have, even if I have to find a way to pay for the consequences.

Sorry, should have added that although these decisions are very difficult -- and we tend to not want to deal with difficult issues -- they are key to getting our national health care expenses in control -- which are key to health care reform.

How can anyone determine who can make it through the procedures to get better and who cannot. My step-mother was diagnosed with lymphoma at 79. She was treated with all the chemotherapy she could handle. It almost killed her. Her cancer has disappeared. She is doing great, enjoying life! She is 81 years old.
My mother fell, she was ill with respiratory issues. She broke her wrist, her hip and her shoulder. She recovered. She was 78 years old. She had to work hard to get better and she did. Unfortunately a growth in her lung took over and she was not able to live but a year after working so hard.
Again, how do you determine who gets surgery, who doesn't?
I don't see that keeping people alive is good when they are terminally ill, but how do you really determine who gets help who doesn't?

Families should be having these conversations and everyone should have a Living Will and Health Care Proxy stating what their wishes are.

don't europeans live longer than americans?

My father is 88 and has insurance and Medicare. Though neither will pay for certain things that would enhance his life - a new hearing aid for instance - either would cover any and all heroic hospitalization costs at the "end of life." My sister, with whom he lives, is a cancer survivor who can't get her own insurance now and is too young for medicare.

There are so many reasons we have to have this serious discussion. While 50 million are uninsured and many millions of those do not qualify for any programs, we need to ask: if it were up to the family, would we put our last $50,000 into grandma's exit, or invest it in pre-natal, neonatal, screening for the family wage-earner, etc.

Even typical insurance - as in my dad's case - honors the costly and ignores life-enhancing care. It pays expensive prescriptions, but not supplements that maintain health. The balance is way off.

I am from France and my mom is a dermatologist there. She has EXPLICIT government limits on the amount of money per patient she can charge to the government.

When my grandpa was dying of lung cancer, they gave him morphine for 2 weeks and that was it.

The caller made a good point. Not only are we doing far too many procedures (because that is how revenue is made) but stuff costs more here. T.R. Reid discovered that an MRI scan in Tokoyo cost less than $100. That was because Toshiba discovered a cheaper way to make the machine.

This is a huge problem, my mother worked in healthcare and is 100% covered....as long as she stays in NY...this is a problem when I am the sibling in line to take care of her and I live out of State.

Who moves me or her? Thanks 1199

This discussion about "rationing" of health care at end of life also ties into your conversation with the head of the AMA. He mentioned health care decisions being made between doctor and patient after presenting information on what therapies were most effective -- implying patients would always make "rational" decisions.

Is that true? What to do when someone is told that an expensive therapy has only a 1% chance of working, and still wants that therapy? I don't have any statistics, but think that given the choice, most people will pick this choice -- particularly if there is only a small chance of a particular therapy working.

These questions are very broad and doesn't only apply to end of life decisions. I'm not so sure that Americans are ready to not have that choice in general.

Fractured hip with terminal cancer and your guest suggests pain killers? What if you have a year to live? I know that I would want a replacement and the chance to see the world? Do you have any idea how much we spend on wars, foreign aid, highways, etc -- and yet when it comes to giving people good health and a good end to life we suddenly become penny pinching? Why do we not draw these bright lines when it comes to things like education? Would you say: not all children deserve a good education because we can't afford it as a nation -- let's screen for those most likely to benefit from education and ration it to the 80% who are smartest? Of course not -- we don't bicker about the money, because we see education as a basic RIGHT. Now, of course, we wouldn't want to spend billions on people in persistent vegetative states -- but with all the wealth in this country, with all the money we spend on weapons, etc, when WE DON"T EVEN HAVE HEALTH CARE FOR ALL, why are we already discussing rationing? Don't you see the very questions you're asking already frame the debate? Brian: if YOU had terminal cancer, had a year to live, had a broken hip, would YOU not want the chance to live a normal life?

The other industrial nations of the world cetainly DONT have their health care under control. In Austria the physician went on Strike in 2008. That's control?
The president of Italy had his heart surgery at the Mayo Clinic. Why would he pay to have surgery done at Mayo when he could have had it done for free in Italy?

One of my friends was diagnosed with an orange-sized brain tumor and told he had 3 months to live. It's 9 years later and he's still alive and is grateful to be so - after much costly treatment. Another friend, also with cancer, after extensive treatment was failing rapidly (and we thought she had weeks left at best and she was about to go into hospice) when the treatment or something kicked in. She's now back home and able to get around (although limited) and is enjoying her (so far) year-long "reprieve". How do we make these hard choices based on cost when we don't know all the answers yet?

a guest notes we need to have a dialogue about "something worse than dying", would be keeping people alive when there is no hope for recovery! That's the point, who is to say there is "no hope", many people believe there is always hope. There are numerous cases of recovery that was never expected and cannot be explained. Ye of little faith.

Is it true that in Japan the cost of an MRI is about one tenth the cost of an MRI in the USA?

And the number of MRI s performed in Japan per capita is very high.

Right, Chris, you got it exactly right.

I am a hospice social worker; I think it would be incredibly helpful to recognize that religious and spiritual leaders need to be involved in this national conversation. Many of the patients and families who were most strongly committed to pursue life at any cost are deeply religious people. Also, I have heard from doctors that they receive virtually NO training on end of life care and death. Medical professionals MUST be able to have open conversations with patients.

The type statements your commentators are making are the same type of pencil pushing policy statements which scares people who are against socialized medicine.

We've been hearing about "choice" at the beginning of life for years. What about "choice" at the end of life?

If someone has the right to "choose" whether or not they will carry a pregnancy to term, they (and the children to whom they may have given birth) should have the right to choose whether or not their life is extended by days, weeks or even years, even if it is just so they can breathe.

yes! life support is a misnomer.. there is no quality of life on the respirator. Those machines support bodily function, NOT LIFE!

Ok, so we are skriting the issue of euthanasia because you're talking about it but don't mention it.

How much has NYC saved in medical $$ since Bloomberg's "Nanny" type acts (cutting smoking, transfats, improving exercise routes, etc.) which surely were imposed at least partly to cut city health costs?

I'm sure he is quantifying this!!

We just in general don't do a good job in healthcare but are too proud of I don't know what to admit it!!

For all the praise of single payer health care, it means that there is rationing, especially at the end of life.

How many end of life insurance co. and tax dollars are directly attributable to voluntary behavior such as alcoholism?

My previous post may give the wrong impression of my thoughts on end-of-life care. I am completely for it and think it should be available to everyone as I think all medical care should be--I support single payer. But I brought up euthanasia as an option TO THOSE WHO WANT IT FOR THEMSELVES and use legal procedures to set up that option.

Are we skirting the issue of euthanasia here? Is the Right to Life movement so strong that we don't even want to bring up the subject? I think individuals who want to have that option ought to have it.

Will you be discussing long-term care insurance?