Is money wasted caring for people in their last year of life?

About a fourth of all Medicare spending pays for medical interventions during the last year of life. A seemingly obvious conclusion is that we could save a lot of money if we cut back on medical interventions for the very old, on the theory that a few extra days or weeks of life are not really worth the high cost, especially if those additional days or weeks are unpleasant.

There are in fact good arguments for preferring palliative care to all-out medical efforts to save a life that realistically can’t be saved. There’s even evidence that many people not only suffer less but even live longer with hospice treatment as opposed to extreme interventions until the very end.

But as pediatrician and Indiana University medical professor Aaron Carroll explains in the video below, things aren’t as simple as they might seem. In a lot of cases doctors simply don’t know whether a given very sick patient will respond well to a treatment. Some in very bad shape recover completely. And not all extreme measures are painful or unpleasant. Some improve the quality of life.

Surprisingly, despite far higher per capita healthcare spending in the United States than in other large and wealthy countries, the U.S. actually spends less on end-of-life than many others do.

Dr Carroll also addresses some other misconceptions about Medicare here. (Many still seem not to know that it doesn’t cover long-term skilled nursing care, for example, or that plain traditional Medicare has no cap on sending unless you get a Medigap policy or Medicare Advantage, and the latter has some limitations.


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