Time to Discuss Limiting Health Care?

Health care costs are exploding.  Medicare costs are growning at a double digit rate. Our system is overtaxed.  We all know this.  We read about it in the newspaper nearly everyday.

Because I pay for my own health insurance I see it in my pay stub.  This year I’m paying nearly $1200 a month for Blue Cross Blue Shield insurance. And even though as a society we spend more per capita than other Western countries, still up to 20% of Americans have no health coverage.

As a cardiologist, I’m part of the system.  I know what the costs are for the tests I order for my patients.  Health care isn’t cheap. What never seems to get talked about whenever the high cost of health care is mentioned is the idea of limiting the services we offer based on age or debility.  In other Western countries that offer care to all their citizens certain expensive treatments (kidney dialysis, open heart surgery, coronary stenting)  are limited based on age or debility. In most countries kidney dialysis is not offered to people over 65 years of age.  Open Heart Surgery is also not offered to people who are quite old or infirmed.

In America, we don’t do this.  Even when people are very, very sick and it is clear that they don’t have more than a year to live we still offer treaments that cost $100,000-200,000.   Resources are limited.  They are.  We can’t deny it.  As a society we have to choose where we are going to spend our dollars.

Now I don’t claim to have any answers to this question.  And I wouldn’t suggest that age alone be a deciding factor for treatment decisions, but what I do suggest is that it’s time to be having public discussion around the issue of how we spend the money that’s available.Quite frequently, as physicians we see very debilititated patients who have multiple systemic problems:  heart disese, lung disease, kidney failure – and then get admitted to the hospital for an acute serious illness.  Even though the chances of survival are less that 1/1000 we don’t limit our treatment.With all the discussion of National Health Care or One Payer System I still don’t see any debate regarding this issue.  It’s like we’re afraid to even talk about it.  Should we limit the care we give to people with little chance of survival?  Should we consider age in our decisions about health care provision?As I said, I don’t have the answers, but I think its time to at least open the door for discussion about the choices we make as a society.

November 5th, 2007