The competing streams of revenue that keep patients away from facing their dying

Yesterday, on American Public Media's Marketplace, (at about 21:30 on the podcast) Kai Ryssdal and Caitlan Carroll explore why we spend so much on end-of-life treatments even though those treatments are not wanted by patients.  Here are a few excerpts from the transcript:

"Respirators, pacemakers and dialysis machines can keep our organs functioning when they no longer work so well on their own. New drugs and treatments stave off the effects of chronic diseases like cancer and AIDS for years. As a country, we've invested billions in the promise of life-saving technology."

"HENRY AARON: At a certain point, layering on additional care -- as many people have put it -- extends dying but does not really extend life."

"The process can also send families into financial ruin. And it's not the way most patients say they want to die. According to the Dartmouth Atlas Project, which tracks health care trends, more than 80 percent of patients say they don't want to be hospitalized or given intensive care during the last phase of their lives."

"So why are so many getting it? It's simple and complicated. No one wants to give up. Not families. Not patients or doctors. And then there's the health care system itself."

"DON SCHUMACHER: When you look at the health care system as a whole, there are competing streams of revenue that could keep patients away from facing their dying.  Everybody has, if you will, a dog in the end-of-life care fight."

"That's Don Schumacher. He heads the National Hospice and Palliative Care Organization. It concentrates on helping people with chronic and terminal disease stay comfortable, rather than trying to cure what cannot be cured. What Schumacher means is that the health care system is built on incentives that are tied to more care."