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Saturday, April 26, 2008

Medicare could have paid for an entire preventive health program: End of life care

Dr. Sam Forman's story
My mother, Rose, was a 4'11" firecracker of South Philadelphia womanhood. She fit a disproportionate interest in humanity and a high decibel level into a small package. That came in handy when she worked during World War II as an inside riveter in the nether regions of B-24 Liberator bomber tail sections: she was a real life Rosie the Riveter.

Much later, in her 80s, she was struck by a heart attack. Over the course of a year, she became the consumer of a dizzying array of specialist physicians and nurses, high-tech diagnostics, cardiac surgery, novel pharmaceuticals, therapeutic devices, and specialty-care facilities. As the family member most suited to be her guide through the maze, I was struck by the providers of all stripes posed with hair triggers to unleash the most novel, the most innovative, and coincidentally the most expensive therapies. After initial treatment reversals leading to scant hope of returning to the independent life she treasured, the collective system would not hear the patient Rose's desires for a less aggressive, more personal and dignified approach.

After her ordeal finally ended, my siblings and I noted that what Medicare had spent on our mother could have paid for prenatal care in broad swaths of inner-city Philadelphia, or an entire preventive health program in some third-world country. All Rose had wanted was to pass on quietly to, as she viewed it, rejoin her husband, Akiba, who had died 10 years before. All the while, providers, institutions, and suppliers were doubtless counting their consumer scorecards. I suspect that the fruitless surgical interventions were probably counted as successes, given what I know about the definitions and time frames of such total quality measures in the increasingly consumer-oriented clinical world.

We can do better for Rosie the Riveter and, indeed, for ourselves and American society.

Advice: You can opt out of aggressive care. Consider hospice care for gravely ill family members.

Browse for related stories in the index at the very bottom of this page, or read an end of life story.

Thanks to Dr. Sam Forman for the source story, published in the Spring 2008 issue of Q3, a publication of the Yale School of Organization and Management.

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