Off the Backs of the Dying
by Judy Bachrach
SEPTEMBER 25, 2008 TAGS:
Despite the melancholy nature of the activity, people in the United States are still dying – quite steadily, obstinately and at the rate of 3.5 million to 4 million a year. Every year. Only the Bush administration appears to be either indifferent to or unaware of this ongoing trend.
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How else to account for its unilateral decision (meaning Congress was never asked about it, never voted on it, and had no part in it), which will directly affect the treatment of our nation’s terminally ill? Starting on Oct. 1, Medicare will start cutting $2.1 billion in reimbursements for hospice care. It is estimated that this will result in hospice staffing cuts – doctors, nurses, social workers, bereavement counselors, and eventually hospice services. And these reductions will affect the people least capable of fighting back.
Or, as Don Schumacher, president of the National Hospice and Palliative Care Organization (which is, among other things, the lobbying group for hospices), puts it: “That $2 billion the government wants to save? They’re doing it off the backs of dying people in the United States.”
Just a few weeks ago in response to Medicare’s decision, NHPCO, not a famously histrionic organization, did the unthinkable. It decided to sue both Medicare and Health and Human Services Secretary Michael Leavitt. The organization is not suing for money – not exactly. Mainly, it wants the government to rescind its hefty cut, which was sneaked into a two-sentence passage of this year’s budget package. But it’s also asking federal judge Colleen Kollar-Kotelly of the U.S District Court to make the government pay for its lawyers’ fees, and you can sort of understand why. These are expected to exceed $250,000.
Suing the government with no guarantee of recouping the considerable cost of going to court is, as Jonathan Keyserling, the organization’s lawyer and lobbyist, will be the first to admit, a little weird, especially coming from an outfit whose members traditionally have their hands outstretched toward the federal trough. After all, the average terminally ill American who gets hospice care will find just one silver lining adorning his extremely sad situation: He doesn’t have to pay for it, or at least not much of it. The cost of such care these days is mostly covered by Medicare – almost 80 percent.
So when Keyserling tells me, “Absolutely, some people in our organization were nervous about the lawsuit. That’s not something we entered into lightly,” he’s probably understating events. Nor is he, given the current disastrous economic and political climate, 100 percent optimistic about the outcome of the lawsuit. “My nickname around here,” he says, “is Eeyore.” On the other hand, he adds, “I also buy lottery tickets.”
So how bad can things get for members of the Boomer generation – and just about anyone else who is inching toward mortality? A little background and even a few statistics are in order here, so bear with me. About 1.4 million people receive hospice services these days, meaning more than one third of those who will shortly end up dead: Hospice care is generally only for those within their last six months of life, and its mission is not to prolong existence, but to make those last months bearable and, ideally, pain-free.
(In fact, the best and most effective treatments for very bad pain are to be found not at the doctor’s office but in hospice in-patient units: There no one is shy about administering morphine or even methadone to the dying. And no one is going to lecture patients on the perils of addiction.)
.jpg)
However, supplying palliative care, aid and comfort to the terminally ill doesn’t come cheap. Four years ago, the price tag came to $6.4 billion – a $4 billion increase over expenditures in 2000. And the costs keep on growing. AARP, in a study that must have terrified the current administration, recently projected that spending on hospice services is increasing by 9 percent annually, and will continue to do so for some years to come.
But what few people realize is that these rising costs are the result of an extraordinary, and rarely mentioned, success story. In the late ’70s practically no one in this country even knew what a hospice was. If you were near death, middle-class, and well insured, more likely than not you’d find yourself shuttling in and out of hospitals for wildly expensive and often painful last-minute surgery, intubation or resuscitation – to absolutely no avail. There wasn’t much choice back then.
In 1984 there were just 31 Medicare-certified hospices, and two years later, when I started volunteering at a Washington, D.C., hospice, most of my friends expressed bewilderment over the choice: What, they wondered, could anyone do for the dying? There are now 3,078 hospices around the country. Contrary to what most people believe, the majority of the terminally ill never see the inside of a hospice in-patient unit, unless they’re in severe pain or have a condition that needs to be stabilized. Most are treated at home by hospice-trained nurses, social workers, and volunteers.
Another little-mentioned nugget of valuable information: Last year Duke University released a study on hospice cost-effectiveness, which was published in the journal Social Science and Medicine. “We found that hospices reduce Medicare spending by an average of $2,309 per person compared to normal care, which typically includes expensive hospitalizations near death,” said Don Taylor, an assistant professor of public policy who was also the primary author of the study.
Taylor added that although the average terminally ill person gets hospice care for only 15 days, it might be better to extend that period. His study “found that patients who use the benefit for the last seven to eight weeks of life maximize cost savings….” They also got “to fully experience the benefits of hospice, such as bereavement counseling, palliative care, and respite for care-givers.”
In fact, he concluded, “The hospice benefit appears to be that rare situation where something that improves quality of life also saves money.”
But try telling that to the government.
--
To support the National Hospice and Palliative Care Organization’s lawsuit go to www.nhpco.org
READ MORE FROM OBIT
Judy Bachrach's Do Not Die Here, runs down the worst funeral laws in the country.
Leslea Newman's Helping Victor Die recounts a friend's last days.
Suzanne Strempek Shea reviews The Healing Touch: True Stories of Life Death and Hospice.
How else to account for its unilateral decision (meaning Congress was never asked about it, never voted on it, and had no part in it), which will directly affect the treatment of our nation’s terminally ill? Starting on Oct. 1, Medicare will start cutting $2.1 billion in reimbursements for hospice care. It is estimated that this will result in hospice staffing cuts – doctors, nurses, social workers, bereavement counselors, and eventually hospice services. And these reductions will affect the people least capable of fighting back. Or, as Don Schumacher, president of the National Hospice and Palliative Care Organization (which is, among other things, the lobbying group for hospices), puts it: “That $2 billion the government wants to save? They’re doing it off the backs of dying people in the United States.”
Just a few weeks ago in response to Medicare’s decision, NHPCO, not a famously histrionic organization, did the unthinkable. It decided to sue both Medicare and Health and Human Services Secretary Michael Leavitt. The organization is not suing for money – not exactly. Mainly, it wants the government to rescind its hefty cut, which was sneaked into a two-sentence passage of this year’s budget package. But it’s also asking federal judge Colleen Kollar-Kotelly of the U.S District Court to make the government pay for its lawyers’ fees, and you can sort of understand why. These are expected to exceed $250,000.
Suing the government with no guarantee of recouping the considerable cost of going to court is, as Jonathan Keyserling, the organization’s lawyer and lobbyist, will be the first to admit, a little weird, especially coming from an outfit whose members traditionally have their hands outstretched toward the federal trough. After all, the average terminally ill American who gets hospice care will find just one silver lining adorning his extremely sad situation: He doesn’t have to pay for it, or at least not much of it. The cost of such care these days is mostly covered by Medicare – almost 80 percent.
So when Keyserling tells me, “Absolutely, some people in our organization were nervous about the lawsuit. That’s not something we entered into lightly,” he’s probably understating events. Nor is he, given the current disastrous economic and political climate, 100 percent optimistic about the outcome of the lawsuit. “My nickname around here,” he says, “is Eeyore.” On the other hand, he adds, “I also buy lottery tickets.”
So how bad can things get for members of the Boomer generation – and just about anyone else who is inching toward mortality? A little background and even a few statistics are in order here, so bear with me. About 1.4 million people receive hospice services these days, meaning more than one third of those who will shortly end up dead: Hospice care is generally only for those within their last six months of life, and its mission is not to prolong existence, but to make those last months bearable and, ideally, pain-free.
(In fact, the best and most effective treatments for very bad pain are to be found not at the doctor’s office but in hospice in-patient units: There no one is shy about administering morphine or even methadone to the dying. And no one is going to lecture patients on the perils of addiction.)
However, supplying palliative care, aid and comfort to the terminally ill doesn’t come cheap. Four years ago, the price tag came to $6.4 billion – a $4 billion increase over expenditures in 2000. And the costs keep on growing. AARP, in a study that must have terrified the current administration, recently projected that spending on hospice services is increasing by 9 percent annually, and will continue to do so for some years to come.But what few people realize is that these rising costs are the result of an extraordinary, and rarely mentioned, success story. In the late ’70s practically no one in this country even knew what a hospice was. If you were near death, middle-class, and well insured, more likely than not you’d find yourself shuttling in and out of hospitals for wildly expensive and often painful last-minute surgery, intubation or resuscitation – to absolutely no avail. There wasn’t much choice back then.
In 1984 there were just 31 Medicare-certified hospices, and two years later, when I started volunteering at a Washington, D.C., hospice, most of my friends expressed bewilderment over the choice: What, they wondered, could anyone do for the dying? There are now 3,078 hospices around the country. Contrary to what most people believe, the majority of the terminally ill never see the inside of a hospice in-patient unit, unless they’re in severe pain or have a condition that needs to be stabilized. Most are treated at home by hospice-trained nurses, social workers, and volunteers.
Another little-mentioned nugget of valuable information: Last year Duke University released a study on hospice cost-effectiveness, which was published in the journal Social Science and Medicine. “We found that hospices reduce Medicare spending by an average of $2,309 per person compared to normal care, which typically includes expensive hospitalizations near death,” said Don Taylor, an assistant professor of public policy who was also the primary author of the study.
Taylor added that although the average terminally ill person gets hospice care for only 15 days, it might be better to extend that period. His study “found that patients who use the benefit for the last seven to eight weeks of life maximize cost savings….” They also got “to fully experience the benefits of hospice, such as bereavement counseling, palliative care, and respite for care-givers.”
In fact, he concluded, “The hospice benefit appears to be that rare situation where something that improves quality of life also saves money.”
But try telling that to the government.
--
To support the National Hospice and Palliative Care Organization’s lawsuit go to www.nhpco.org
READ MORE FROM OBIT
Judy Bachrach's Do Not Die Here, runs down the worst funeral laws in the country.
Leslea Newman's Helping Victor Die recounts a friend's last days.
Suzanne Strempek Shea reviews The Healing Touch: True Stories of Life Death and Hospice.
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Anonymous wrote on September 25, 2008 5:44pm
damn. [Report Comment]
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