December 3, 2010 6:05 PM
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The Cost of Dying
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FILE - This July 26, 1972 file photo shows actress Ann Rutherford gazing at old sets on the MGM studioâs Lot 2 in Los Angeles where she and Mickey Rooney filmed the Andy Hardy series. Rutherford, who played Scarlett O'Hara's sister Carreen in the 1939 movie classic "Gone With the Wind," died at her home in Beverly Hills, Calif. on Monday, June 11, 2012. She was 94. (AP Photo/JLR, file) (JLR)
In almost every business, cost-conscious customers and consumers help keep prices down. But not with health care. That's because the customers and consumers who are receiving the care aren't the ones paying the bill.
"The perverse incentives that exist in our system are magnified at end of life," David Walker, the government's former top accountant told Kroft.
Walker used to be the head of the Government Accountability Office. He now heads the Peter G. Peterson Foundation, which is a strong advocate for reducing government debt. He says that 85 percent of the health care bills are paid by the government or private insurers, not by patients themselves. In fact most patients don't even look at the bills.
"Does that make any sense to have, I mean, most things you buy, the customer has some impact," Kroft remarked.
"We have a system where everybody wants as much as they can get, and they don't understand the true cost of what they're getting. The one thing that could bankrupt America is out of control health care costs. And if we don't get them under control, that's where we're headed," Walker said.
With end-of-life care, there are also delicate cultural and political considerations.
Patients, with their families' support, want to cling to life, and it is often easier to hope for a medical miracle than to discuss how they want to die.
Charlie Haggart is 68 years old and suffering from liver and kidney failure. He wants a double transplant, which would cost about $450,000. But doctors have told him he's currently too weak to be a candidate for the procedure.
At a meeting with Haggart's family and his doctors, Dr. Byock raised the awkward question of what should be done if he got worse and his heart or lungs were to give out.
He said that all of the available data showed that CPR very rarely works on someone in Haggart's condition, and that it could lead to a drawn out death in the ICU.
"Either way you decide, we will honor your choice, and that's the truth," Byock reassured Haggart. "Should we do CPR if your heart were to suddenly stop?"
"Yes," he replied.
"You'd be okay with being in the ICU again?" Byock asked.
"Yes," Haggart said.
"I know it's an awkward conversation," Byock said.
"It beats second place," Haggart joked, laughing.
"You don't think it makes any sense?" Kroft asked the doctor.
"It wouldn't be my choice. It's not what I advise people. At the present time, it's their right to request it. And Medicare pays for it," Byock said.
When it comes to expensive, hi-tech treatments with some potential to extend life, there are few limitations.
By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.
"I think you cannot make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say 'We simply do not put defibrillators into people in this condition.' Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that's going to outrage a lot of people."
"But you think that should happen?" Kroft asked.
"I think at some point it has to happen," Byock said.
"Well, this is a version then of pulling Grandma off the machine?" Kroft asked.
"You know, I have to say, I think that's offensive. I spend my life in the service of affirming life. I really do. To say we're gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it's certainly scurrilous when we have 46 million Americans who are uninsured," Byock said.
Copyright 2010 CBS. All rights reserved. "The perverse incentives that exist in our system are magnified at end of life," David Walker, the government's former top accountant told Kroft.
Walker used to be the head of the Government Accountability Office. He now heads the Peter G. Peterson Foundation, which is a strong advocate for reducing government debt. He says that 85 percent of the health care bills are paid by the government or private insurers, not by patients themselves. In fact most patients don't even look at the bills.
"Does that make any sense to have, I mean, most things you buy, the customer has some impact," Kroft remarked.
"We have a system where everybody wants as much as they can get, and they don't understand the true cost of what they're getting. The one thing that could bankrupt America is out of control health care costs. And if we don't get them under control, that's where we're headed," Walker said.
With end-of-life care, there are also delicate cultural and political considerations.
Patients, with their families' support, want to cling to life, and it is often easier to hope for a medical miracle than to discuss how they want to die.
Charlie Haggart is 68 years old and suffering from liver and kidney failure. He wants a double transplant, which would cost about $450,000. But doctors have told him he's currently too weak to be a candidate for the procedure.
At a meeting with Haggart's family and his doctors, Dr. Byock raised the awkward question of what should be done if he got worse and his heart or lungs were to give out.
He said that all of the available data showed that CPR very rarely works on someone in Haggart's condition, and that it could lead to a drawn out death in the ICU.
"Either way you decide, we will honor your choice, and that's the truth," Byock reassured Haggart. "Should we do CPR if your heart were to suddenly stop?"
"Yes," he replied.
"You'd be okay with being in the ICU again?" Byock asked.
"Yes," Haggart said.
"I know it's an awkward conversation," Byock said.
"It beats second place," Haggart joked, laughing.
"You don't think it makes any sense?" Kroft asked the doctor.
"It wouldn't be my choice. It's not what I advise people. At the present time, it's their right to request it. And Medicare pays for it," Byock said.
When it comes to expensive, hi-tech treatments with some potential to extend life, there are few limitations.
By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.
"I think you cannot make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say 'We simply do not put defibrillators into people in this condition.' Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that's going to outrage a lot of people."
"But you think that should happen?" Kroft asked.
"I think at some point it has to happen," Byock said.
"Well, this is a version then of pulling Grandma off the machine?" Kroft asked.
"You know, I have to say, I think that's offensive. I spend my life in the service of affirming life. I really do. To say we're gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it's certainly scurrilous when we have 46 million Americans who are uninsured," Byock said.
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