[quote=bearishgurl][quote=SK in CV][quote=bearishgurl]SK in CV, I don’t know how 60 minutes came to that conclusion, then. IMO, insurance companies and Medicare should be willing to pay for hospice up to six months or about $50K. Acc. to 60 minutes, that’s roughly five days in the ICU.[/quote]
Not sure, I’ll take a look at the video later. But the date on the article is 11/22/09. The bill underwent hundreds, maybe thousands of changes before it passed 4 months later.
Medicare does pay for hospice. As does most private medical insurance (in addition to Medi-Cal and TRICARE). For those uninsured or covered by private insurance that doesn’t include hospice care, hospice care is still available at little or no cost for those that can’t afford it.[/quote]
This is very good to know. Thank you, SK in CV![/quote]
Actually, I heard quite a bit of discussion about hospice/end-of-life options from some of the politicians who were proponents of the health reform bill. It’s not surprising that it didn’t make it into the forefront of media coverage at that time. After all, calm and reasoned discourse about a humane and relatively inexpensive way to care for terminally-ill patients can never hope to trump visions of death panels by politicians and attendees alike at Jerry Springer-like town hall meetings when a news show producer is selecting footage.
Medicare has been quite good about encouraging and covering hospice care for some time now. Again, most Americans, including our esteemed lawmakers, are woefully uneducated about the health care delivery system in which they are seeking to make profound change. Most know absolutely nothing about the hospice option, since they, or members of their family, have not been in a position to require it. However, Medicare policymakers have recognized both the economic and sociological advantages.
This happens in situations where the legal obligation to provide across-the-board services exists. Private health insurance companies are well aware of the cost advantages of hospice over hospitalization. However, no end-of-life care is far cheaper than hospice, and private insurers have that option.
When physicians stop cure-centered treatment of a patient, either because none exists or because the patient/family has requested it, the patient enters the realm of palliative care. Most private health insurance carriers will not provide coverage of palliative care-related hospitalization. The hospital alerts the family that there will be no further third-party payments, and the family then has the options of moving the patient to an assisted-care facility, to a hospice provider, or to their home where they will have to provide the patient’s care themselves (they also have the option of leaving the patient in the hospital and paying the entire bill themselves).
While there are some private carriers who do assist in paying for some or all of these options, many do not. There’s no financial incentive for them to do so. They know that the patient’s family will continue to pay the premiums until the patient’s death, so they’re not concerned about loss of income. They realize that the patient’s family will probably provide the care if forced into it by cost. But, overall, what happens to the terminally-ill patient is of little concern to them.
This disparity between Medicare and private health insurers is due to demographics. Medicare is an entity whose enrollees are, overall, much older, and their illnesses tend to be more serious and complex than those affecting younger people (below age 60), and the age- and lifestyle-related deterioration in their physiologic systems cause more negative reactions to treatment. Because Medicare is a congressionally-mandated program which ostensibly offers the same coverage to all, and because the vast majority of enrollees requires advanced (read as expensive) care, it is essential that Medicare exercise some creativity in finding ways to reduce their costs while providing mandated care for patients. Enter hospice care.
Private insurers are under no such obligation. They’ve winnowed out as much of the risk as possible by refusing to enroll at-risk people (including those with at-risk spouses and children), creating a very favorable risk pool. On the rare occasions that one of the enrollees develops metastatic cancer, or a heart condition, or an autoimmune disorder, the focus is not on finding cost-effective ways of providing health care for that patient, but on not paying for care at all. From the moment that diagnosis code is entered in their system, the patient is subjected to special attention from their insurer: receiving letters questioning their eligibility (even though they’ve been paying premiums for 20 years, without using benefits), denial of coverage for myriad reasons, and, often, termination of their coverage. Even in cases where the insurer is legally obligated to provide contracted services, they will often refuse to do so, attempting to delay such time as they have to part with money. They are hoping to hit the jackpot, and often do: the patient is too sick, and their families are too inexperienced or too busy to maneuver thru the morass, and they simply give up fighting.
I believe this is the reason for much of the public’s aversion to health reform: circumstances in their lives have been such that they have not experienced a need for major health care services. As such, they cannot be expected to know that, not only is the deck stacked against them if they should become ill, but that the current “system” is unsustainable in the wake of the health care tsunami headed our way in another few years when half the Boomer population is over 70. Spurred on by opportunistic politicians, corporate executives, and media talking heads, they’ve been worked up a ill-informed lather that will work against their interests and those of their families in the future.
