Palliative care and medical costs

At a panel on life sciences venture capital and life sciences in the Triangle the other day, there was a guy from the venture arm of Blue Cross Blue Shield NC and some other Blue umbrella corporation. One thing he discussed was palliative care as a big opportunity for cost reduction in our healthcare system.

It is a hard thing to talk about, but we all know it's true. Healthcare is something like 18% of GDP in the US, and we've seen stats on end of life care and how expensive it is.  I could Google them now but don't have time to, I don't need to prove this point. As Boomers continue to retire and move through retirement towards death, the problem will get worse.

A big problem with end of life costs is people and family members failing to accept the writing on the wall, that death is nigh. It is normal and natural for any organism, humans especially included, to seek to perpetuate itself. As the curve of probability tilts progressively against any given human, it's hard to accept or define the point at which it's best to throw in the towel. If there is a 15% chance of two years' survival at the cost of $300,000 and a lot of pain, is it worth it?  People answer this question differently, based on where they are in life and where they are with loved ones.

My mom's husband David just went through this process, fighting cancer until he was out of treatments, then sustaining himself in a hopeless situation for a very short time, really until all of his family had been able to come and say goodbye and come to grips with the situation. Then he let go.

Around the time of the Obamacare debates there was a lot of discussion of "death panels" and government stepping in to make these decisions. In practice, as I understand it, "payers" (insurers) do have discretion to fund or not fund treatment based on a probabilistic assessment of whether the treatment is likely to work for a given patient. Also, health care is effectively rationed structurally: people living close to major medical centers are able to get the best care simply by virtue of having access to doctors who are closer to the center of information flow for their disciplines. On average, they get better care.  On average, these are more affluent people.

Anyway, back to the point about end of life spending. The better people are oriented towards death, the less pain and suffering they will, perhaps, choose to put themselves through as the probability charts bend against them late in life. In this regard, Atul Gawande's Being Mortal and other books that help us think about this issue are good, as is a family culture of staying in touch and talking throughout life (so there's less unfinished business), and, for that matter, religion can help too.

Ultimately, the problem will solve itself.  People won't spend 10% of GDP on weeks of misery in hospitals.