By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: End-of-Life Care? Maybe
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Public Health > End-of-Life Care? Maybe
Policy & LawPublic Health

End-of-Life Care? Maybe

ckapsa
ckapsa
Share
7 Min Read
SHARE

Death Be Not Proud

End-of-life discussions are the discussions du jour among the affluent chattering classes. Most of whom are comfortably insured, healthy, with trusted physicians who know them well. (Mea culpa.)

Contents
  • Death Be Not Proud
  • Death Be Not Proud
    • Death Panels Redux?
    • Juxtapositions

Death Be Not Proud

End-of-life discussions are the discussions du jour among the affluent chattering classes. Most of whom are comfortably insured, healthy, with trusted physicians who know them well. (Mea culpa.)

Recent articles appeared in the New York Times about end-of-life care. Pam Belluck wrote “Coverage for End-of-Life Talks Gaining Ground” late last month (http://www.nytimes.com/2014/08/31/health/end-of-life-talks-may-finally-overcome-politics.html). She described ways Medicare and other insurers, including some Blue Cross Blue Shield plans, will pay doctors and other clinicians to talk about peoples’ preferences about life-prolonging care. Most people she interviewed favored the idea. Some strongly so. A week later, readers responded to Ms. Belluck’s piece in a Sunday Review | Letters column dedicated to the topic (http://www.nytimes.com/2014/09/07/opinion/sunday/a-talk-before-dying.html?ref=opinion). Four of the five printed letters were in favor of end-of-life conversations underwritten by insurers. One writer from Sag Harbor, NY demanded such discussions be required. Just one writer, a professor of medicine, urged caution.

End-of-life talks promoted by the well-off are a profoundly troubling notion.

More Read

deliver Patient Outcomes
Patient Outcomes Culture – A Healthcare Game Changer
What the Supreme Court (and You) Won’t Hear About Health Reform
Medical Residents Get Their Own Social Network
Organization fined $418,000 for business associate HIPAA breach
Left to Our Own Devices

Death Panels Redux?

No, not the death panel argument again. Though the prospect that an insurer may benefit from my quick death is disquieting enough. That they’re willing to pay my physician to talk me out of expensive treatment makes it more disturbing. Insurance companies don’t pay for anything unless it delivers a return on investment. Insurers are betting people will ration their own care. Forty bucks for visits that convince folks they don’t want forty thousand dollars’ worth of care is an enviable ROI.

The trouble seeps into the bedrock of our deeply unequal society. These efforts may harden into yet another way to deprive the worse-off of care.  Another way to privatize profits and socialize risks. Under the banner of “personal choice”.

It’s happened before. Secure pensions morphed into 401(k)s so people could “control their retirement money”. Now many Americans will have no retirement because they have no retirement money. High-deductible health plans were originally called consumer-directed health plans. Made the plans sound egalitarian. An increasing number of people are saddled with HDHPs. They have deductibles so high they are, in effect, uninsured. Even for catastrophic costs in some cases.

Juxtapositions

The push for end-of-life discussions percolated up against a backdrop of disheartening news. The Department of Agriculture released the annual report on food insecurity in America this month (http://www.ers.usda.gov/media/1565415/err173.pdf). Fourteen percent of us didn’t get enough to eat in 2013. That’s 17.5 million households. The largest number of hungry souls are in Arkansas at 21 percent of households. North Dakotans fare best. Only 8.7 percent of households there were food-insecure.

The other fascinating read of the past week (no, really) was the bulletin published every three years by the Federal Reserve. Titled Changes in U.S. Family Finances from 2010 to 2013: Evidence from the Survey of Consumer Finances, it’s a thorough study of family finances nationwide (http://www.federalreserve.gov/pubs/bulletin/2014/pdf/scf14.pdf). The survey showed distressing trends and the introduction summarized it nicely: “The 2013 SCF reveals substantial disparities in the evolution of income and net worth since the previous time the survey was conducted, in 2010.”

The survey put numbers to the widening financial inequality in America. Median family income fell 5 percent, as more money flowed upward. Families in the middle have not made up for losses suffered during the collapse of 2007-2010. Families at the “very top” saw widespread income gains compared to the prior survey, though even they were below 2007 highs. Average incomes fell 8 percent for the families in the bottom 20 percent of income distribution. The families in the top 3 percent snagged 30.5 percent of all income last year.

End-of-Life Care?

caring doctor and patientBack to end-of-life-discussions.

Food-secure people with low incomes are more likely to have poor health. They may not have insurance. Or they recently became insured thanks to the ACA, unless they live in states where government intransigence has denied them Medicaid. For employed folks, chances are good their employers offer only HDHPs, with unaffordable deductibles. Maybe they’re lucky. They’re old enough to finally make it to the Medicare promised land.

Food-security has a distribution that tracks income. Families at the top can afford plenty of fresh produce, fish, lean meat and other organic goodies. Families bumping along at the bottom may have enough to eat. They may not go to bed hungry. But bellies are not filled with wild salmon, baby kale and fresh raspberries. Filling, cheap and unhealthy foods are more likely on the menu. Foods that contribute to chronic illness.

Millions of Americans have gone without health insurance for years. They haven’t seen doctors. They eat badly. They have little disposable income. Perhaps their health is poor, beset with diabetes, high blood pressure, heart disease or worse. At long last, able to get some care thanks to Medicare, Medicaid or Obamacare, these people go to doctors for the first time.  To be greeted with, “Congratulations, you finally have insurance. Now, let’s talk about how you want to die.”

Of course, if people don’t want to talk about dying just yet, there’s another way. Maybe they’ll starve first.

Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

dental care
Importance of Good Dental Care for Health and Confidence
Dental health Specialties
October 2, 2025
AI in Healthcare
AI in Healthcare: Technology is Transforming the Global Landscape
Global Healthcare Policy & Law Technology
October 1, 2025
Choosing the Right Swimwear for Health and Safety
News
September 30, 2025
sports concussions
Concussion In Sports: How Common They Are And What You Need To Know
Infographics
September 28, 2025

You Might also Like

Florida’s Problem: Cutting Medicaid May Cost the State More

December 15, 2011
Health careWellness

Everything You Need To Know About Raynaud’s Disease

July 9, 2019

Denmark Introduces “Fat Tax”

October 4, 2011
Breast augmentation: Late-generation models of...
NewsPublic Health

Making Sense of the French Silicone Breast Implant Scare

January 6, 2012
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?