re: #34 lawhawk

He talks more sense than most politicians and pundits, which is why his knowledge and experience will be singularly ignored by those who are in a position to act on this.

The fact is that the bills are written in such a way to influence how doctors treat patients. There are built in incentives - however subtle they may appear to be - but they are incentives.

And the purpose of those incentives is cost-control, primarily because most health care dollars goes to those in the last year of life. It’s where the most savings is hoped to be attained.

My question (which probably should be added to Keith’s invaluable resource) - is what happens when the cost-savings don’t materialize? Who will pick up the tab then, seeing how government rarely shuts down entitlements, instead increasing their deficits and/or raising taxes to cover the shortfalls.

Consider the alternative to end-of-life counseling. The doctor must never say die. There’s always a treatment, a chance, a hope. Even when there isn’t, not really.

I saw this once: patient is dying of lung cancer. He’s scheduled for an operation to remove one of the lungs. They’re both raddled with cancer. He has but little time left. A week or two, tops. But in one of the lungs, things are to the point that unless it goes, he’s dead in a couple of days.

He’s not been told, but he knows anyway. And he asks me to not take him in for surgery. He doesn’t want it. His number is up and please just let him die.

But that’s not my place and not my job. (That’s what they all say, they were just following orders. Trust me, it’s not easy to make a stink and make a moral stand and quit in a huff, when there’s no time to ruminate and you’re just a rookie.) So off he goes to get cut up again. His last days will be an ordeal that Dante’s imagination would have trouble topping.

There is a legitimate case for doctors laying it on the line with a patient, unless the patient has indicated directly or implicitly that he just doesn’t want to talk about or think about anything but persisting with treatment.

If we end up with a state-run health care system, we’ll be sorry for many reasons. But things will be yet worse if the state is constrained by law to shy away from these end-of-life issues. Unless a car wreck or something takes the question off the table, everyone is going to face this decision sooner or later: does further treatment serve any purpose?