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Healthcare's generation gap

The New York Times, 8/16/09

Abstract:

In the 1980s, I worked as a respiratory therapist in intensive-care units in the Midwest, taking care of elderly, dying patients on ventilators. I remember marveling, along with the young doctors and nurses I worked with, over how many millions of dollars were spent performing insanely expensive procedures, scans and tests on patients who would never regain consciousness or leave the hospital.

When the insurance ran out, or Medicare stopped paying, patients and their families gave the hospital liens on their homes to pay for this care. Families spent their entire savings so Grandma could make yet another trip to the surgical suite on the slim-to-none chance that bypass surgery, a thoracotomy, an endoscopy or kidney dialysis might get her off the ventilator and out of the hospital in time for her 88th birthday.

That was back in the mid-’80s, when the nation was spending around 8 percent of its gross domestic product on health care. I and other health care workers solemnly agreed that the spending spree could not continue. Taxpayers and insurance companies would eventually revolt and refuse to pay for such end-of-life care. Somebody would surely expose the ruse for what it was: an enormous transfer of wealth based on the pretense that getting old and dying is a medical emergency requiring high-tech intensive-care intervention and armies of specialists, which could cost $10,000 or more per day. (Europeans have so far resisted this delusion, one reason they spend much less than we do on health care, with far better results.)

But we were wrong. Health care spending has since doubled, to around 16 percent of our gross domestic product, and in the next 25 years or so is projected to reach 31 percent of G.D.P. Despite having those figures in hand, Congress might still pass legislation calling for spending more, not less, on health care, even though we’ve been told for decades that what we spend has almost nothing to do with the quality of care we receive.

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