[jknz]

I am wondering if any cost-analysis studies have been done to assess the trade-off between lengthy end-of-life terminal care and the corresponding cost. Doctors seem to make such decisions all the time; but we may have at some point to discuss collectively how much of the public money involved in end-of-life terminal care (last two months, say) for elderly should be used instead for better care earlier in life.

In countries where such care is provided by private insurance and not the state, I am wondering why this trade-off is not given as a choice to the consumer. Many people might be OK to get smaller premiums and better coverage throughout their life by explicitly rejecting coverage of end-of-life care.

[duxup]

In the US a while back there was a lot of political drama over "death panels". For the record it was all BS there were no "death panels" proposed in Obama care and it was nothing like the people who used that phrase implied.

Interesting enough the one thread that the folks pushing that concept picked out was a provision that paid doctors for consulting with people about what kind of end of life care they would like. That's all it was. There had been strides that showed individuals chose all on their own to refuse some of the most expensive late stage life care after having talked to a doctor about it. The result also meant there was significant cost savings, reduced stress for those dying and their families.

Sadly the BS surrounding "death panels" meant that provision was left out of Obamacare.

I don't know if there is an afterlife with any sort of destination based on people's choices, but I like to think if there is there's a special room in hell for folks who used that provision to score political points, and likely meant that some folks may have suffered more because of it.

[AndrewGaspar]

For better or worse, people don't apply purely rational thinking about trade-offs to healthcare. I think it would make a lot of people squeamish to hear this argument about why somebody, where somebody might be mom or dad, isn't going to receive certain care because they didn't pay for it earlier in their life.

Unfortunately the trade-offs don't go away, and we haven't figured out a way of making these trade offs that doesn't feel horribly statist (so called "death panels") or callous (private insurance denying care).

[dodobirdlord]

> Unfortunately the trade-offs don't go away, and we haven't figured out a way of making these trade offs that doesn't feel horribly statist (so called "death panels")

These already exist. Donor organs are a scarce resource and there aren't enough to go around, so some person(s) has to decide who lives and who dies. People already regularly die in the United States because it is uneconomical to have Level I/II trauma centers within emergency response distance of the entire country.

People have very different ethical standards for how people should act in advance planning scenarios versus in the moment. I think most people agree with the unreasonableness of arranging to have an on call neurosurgeon in a small town in the middle of nowhere. But I think people would have a very different reaction if the same neurosurgeon refused to skip a day of teaching medical students to instead walk across the hospital and carry out a 12 hour brain surgery on a 90 year old patient with dementia who will be dead from lung cancer in two months anyway.

I think people will just have to get over it. There aren't alternatives.

[pkaye]

> Many people might be OK to get smaller premiums and better coverage throughout their life by explicitly rejecting coverage of end-of-life care.

This never works out. Right now many people buy low quality high deductible health insurance expecting never to get sick and then balk when they suddenly get ill and end up paying a huge deductible. People don't assess correctly what they need later in life. When people are denied the health care later due to these decisions, the death panel rhetoric will be brought up.