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HOST) Commentator Bea Grause is head of the Vermont Association of Hospitals and Health Systems. She says that before we can find the right answers to fixing the health care system, we have to start asking the right questions.
(GRAUSE) Lately, I’ve seen everything from newspaper articles to You Tube videos filled with confusing campaign ideas on how to fix our healthcare system. Healthcare certainly is hard to fix for a lot of reasons, but an article I read recently made it clear to me that there are no easy answers. We don’t even know the right questions to ask! The article is titled "Letting Go" and was written by Dr. Atul Gawande, a physician and author who writes regularly about health care reform. This heartbreaking piece delves thoughtfully into the complex dynamics of medical treatment for terminally ill patients. Through his narratives of actual patient stories, Dr. Gawande asks tough rhetorical questions like: When should we give up on medical care when it can’t prolong our life or reduce our suffering? Or how about: When a patient nears the end of their life – who should be the decision-maker? With all our worries about rising healthcare costs, should lawmakers decide – or should it be the patient’s choice to give a costly drug a last-ditch try? It’s important to remember that in the real-life world of healthcare, questions like these get asked hundreds of times a day, millions of times each year, for patients who could be your neighbor, your friend or your daughter.
These questions won’t go away over night – under any newly designed healthcare system. The painful and deeply personal choices patients and families will face certainly won’t get any easier.
Dr. Gawande – as a practicing surgeon – believes that we’ve created a multi-trillion dollar health care system for "delivering the medical equivalent of lottery tickets." In other words, we spend millions trying to prolong patients’ lives when there is virtually no hope for them. In contrast, we spend far less for terminally-ill patients to help them confront their death so that they can live their final days to the fullest. His lottery ticket analogy is supported by data showing that 25% of Medicare spending is spent on just 5% of Medicare beneficiaries in their last year of life.
Deciding at a societal level to just cut spending or change who pays for all this care ignores the real-life dramas and gut-wrenching decisions that go on in our hospitals, clinics and homes every day. It’s these exquisitely personal decisions that drive healthcare spending. As individuals, we also have to understand that turning this battleship that we call healthcare reform will take years of policy changes along with community conversations, and ultimately a cultural shift in how we as Vermonters – and Americans – expect to live our lives and ultimately end them.