Scare stories from Sarah Palin and Chuck Grassley about “death panels” didn’t succeed in derailing efforts to expand health insurance coverage, but they did help the health insurance industry shield its conduct from some much-needed scrutiny. Two recent posts, one from Igor Volsky discussing doctors’ tendency to prescribe useless aggressive treatment options for men with low-risk prostate cancer and one from Ezra Klein citing Atul Gawande on making terminally ill patients miserable with dignity-sapping extraordinary measures.
This is all bad stuff and not primarily because it “costs money.” Rather, it costs people quality of life. People have better things to do with their time than undergoing painful cancer treatments that they don’t need. Gawande writes of a study “showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions” and also “six months after their death, their caregivers were three times as likely to suffer major depression.” I don’t think there’s anyone out there who’s terminally ill and saying to himself “I want to handle this in the way most likely to produced major depression for my loved ones” but that’s what happens and it’s horrible.
Unfortunately, even post-reform our health care policies are going to skew incentives in favor of too-little preventive care and too much end-of-life care as well as too much health care and not enough healthy living. But we are slowly making progress.