The New Health Dialogue

The Health Policy Program invites you to join us at an event tomorrow from 12 to 2pm to discuss the controversial issue of end-of-life care, and the implications it holds for patients, families, providers and yes -- even those who pay for the care. While last year's contentious health reform debate painted the issue in harsh and often equivocal terms, the choices around end-of-life care are complex and deeply personal and are not a simple contrast between cure vs. care.

At the event, Moving Beyond Death Panels, a distinguished panel of experts will discuss the implications of the most recent Dartmouth Atlas, "Quality of End-of-Life Cancer Care for Medicare Beneficiaries Regional and Hospital-Specific Analyses." This study reinforces previous findings that the end-of-life care patients receive often falls short of their desires and wishes, and those of their families. All health care, including -- if not especially -- that which comes at the end of life, must be responsive to patients' needs and respectful to their personal values.

Lunch will be available at noon. To RSVP or see a full list of speakers, click here. If you can't make it in person, be sure to follow along on our Twitter account, NewHealthDialog. We'll be live-tweeting under the hashtag #nafevents. We hope to see you there!

People by now have had a few days to digest the National Commission on Fiscal Responsibility and Reform's co-chairmen’s deficit-reduction draft. As you know, the initial news accounts focused on Social Security and taxation in general. (For some reason, that proposal to stop paying states and territories for abandoned mines just didn’t grab those headlines.) We thought it would be useful to take another look a few days out at the health aspects.  

What all of the recommendations will look like by the time it gets to Congress (if it gets to Congress) is anyone's guess. But the irony, the great great irony, is that all the people who resisted health reform because somehow they thought that the current system was sustainable, are going to have a pretty unpleasant shock. We either bring health care spending under control the pretty way, or a reasonable facsimile of a pretty way (trying to create an efficient, equitable, evidence-based system) or we do it ugly. (Slash and burn.) The economic reality of our country now is that pure pretty probably isn't an option. There's going to be some pain. We just don't want to see the slashing and burning falling hardest on those who can least afford to be slashed and burned.

Yesterday we brought you the highlights of the Dartmouth Atlas study on the end of life treatment experiences of Medicare patients with advanced cancer. Lots of last minute hospitalization and rescue care,  hospice was too little and too late, and the significant regional variation that Dartmouth has been documenting in excruciating detail for 20 years.

We promised more when I finished a longer piece. Here's the link to that piece, "For Dying Cancer Patients, Geography is Destiny." Here is some of what I reported:

We are giving an awful lot of very aggressive care to patients who are pretty close to death, with advanced and advancing metastatic cancer. As health care consultant Rosemary Gibson said, "We still don’t know when to stop."

The Dartmouth Atlas has released a report on the wide variation in cancer care at the end of life for Medicare patients. Lots of variation in ICU care and hospitalization -- in some regions, more than a third of the patients with severe, advanced cancer spent their final days in the hospital, some with ventilators, feeding tubes or other intensive life support. The following Dartmouth Atlas graph, for example, shows the percent of cancer patients who died in a hospital across the United States between 2003 and 2007 -- averaging about 29 percent. That's not how the vast majority of Americans say they want to die -- most of those with serious illness say they would prefer to be at home with their families.