The Dartmouth Atlas Project has released a report today that hospital stays in the last six months of life are up, and treating chronic illnesses in the last two months of life uses up about one-third of all Medicare dollars. Despite that, most Americans say they don't want to be hospitalized while they are dying. In a story about the finding, the Associated Press Huffington Post tells the story of a 32-year-old woman who died of a brain tumor whose family says she would have forgone those needless surgeries and treatments had she known she could.
While end-of-life care is certainly the boogeyman that helped fuel the "death panels" nonsense, it is uncomfortable to talk about palliative care and other treatments for the dying in terms of cost-effectiveness. But what this also should punch a hole in is the persistent and annoying theory that Americans are actually actively driving up their own health-care costs by demanding needless treatments despite doctors' advice and threatening to sue if they don't get it. The theory is that if we forced people to pay more out-of-pocket for each procedure, we'd end the all-you-can-eat buffet approach patients take to care.
But what probably happens just as often is that doctors don't communicate well to patients about what is likely, or what they need, or doctors order needless tests because they have the patient in their care anyway and want to be on the safe side. I'm a pretty well-educated person, but if I'm in a doctor's office and I find out something might be wrong with me, I'm going to pretty much do whatever they say and figure out how to pay my share later. I'm not going to haggle, and I'm not going to question whether a test "just to be safe" is the right idea.
This is one of the reasons health-care costs are so different from other markets. As Matt Yglesias wrote, we demand the care part of health care, and a bargain doesn't sound as good as a bargain on a dining set would be. But also, it involves life or death, and there is a fundamental information asymmetry between the patient and the doctor. This is why the price controls have to come from the people who pay, who can conduct and trust the kinds of studies that tell them what requires intervention and when it's best to let someone let go.
UPDATE: The earlier version of this post misattributed the story, and also said the report was released today when the data is actually older.
-- Monica Potts
