What the "death panel" lies have "protected" us from discussing about end-of-life care

"About $67 billion -- nearly a third of the money spent by Medicare -- goes to patients in the last two years of life. The need to spend less money at the end of life 'is the elephant in the room,' Evan Thomas wrote in 'The Case for Killing Granny,' the cover story in last week’s Newsweek. 'Everyone sees it but no one wants to talk about it.'"

-- Timothy Egan, in his Tuesday night NYT "Outposts"
blogpost, "The Way We Die Now"

by Ken

John Kitzhaber, M.D., was governor of Oregon from 1995 to 2003. He's 62 now, and has announced his intention to seek the office again next year. After he left the statehouse, his 88-year-old mother, Annabel, "with a weak heart, and tests that showed she most likely had cancer" (according to the above-linked Timothy Egan NYT blogpost), made the decision "to go home, walking away from the medical-industrial complex," and spend her remaining time with her also-failing husband, Albert. Annabel Kitzhaber died four months later, in 2005; Albert died eight months after that.

“The whole focus had been centered on her illness and her aging,” the Kitzhabers' son the former governor told former NYT reporter Timothy Egan in his Tuesday night NYT "Outposts" blogpost. “But both she and my father let go that part of their lives that they could not control and instead began to focus on what they could control: the joys and blessings of their marriage.”

Egan does a lovely job telling the story of those end-of-life decisions of Annabel and Albert Kitzhaber and the story of John Kitzhaber's horror at the way the end-of-life subject has (finally!) entered the national conversation. Egan writes:

Nobody was more frustrated than John Kitzhaber as the health care debate got hijacked over the summer by shouters and misinformation specialists. And no politician is more battle-scarred on this issue. He looks, at 62, still the Western man, with his jeans, his shag of gray hair, the face weathered by days spent trying to lure steelhead to the surface in the Rogue River. It has been his life work to see if at least one part of the country could join the family of nations that offers universal coverage.

With his mother's death in 2005, Kitzhaber lived the absurdities of the present system. Medicare would pay hundreds of thousands of dollars for endless hospital procedures and tests but would not pay $18 an hour for a non-hospice care giver to come into Annabel's home and help her through her final days.

"The fundamental problem is that one percent of the population accounts for 35 percent of health care spending. So the big question is not how we pay for health care, but what are we buying."

He is not, he says, in favor of pulling the plug on granny. The culture of life should be paramount, he says, following the oath he took as a doctor. But Oregon, years ahead of the rest of the country, has talked and talked and talked about this taboo topic, and they’ve voted on it as well, in several forms. They found -- in line with national studies -- that most people want to die at home.

The governor insists that we really do need to rethink the way we spend health care dollars on the dying -- not setting up death panels, but recognizing that aging is not a "disease" that can be "cured," as part of a process of rethinking the way we spend precious health care dollars on terminal patients. It's a piece that's well worth your time.

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