Cancer Center's Ira Byock and TDI's Elliott Fisher Featured on 60 Minutes
November 23, 2009
One of the biggest problems in health care is that many Americans are "dying badly," says Ira Byock, MD, director of the Palliative Care Program at Norris Cotton Cancer Center. He says many Americans spend their last days in an intensive care unit, relying on uncomfortable machines or surgeries to prolong their lives a few more days or weeks at enormous cost. Byock was interviewed in a story about the cost of dying in America broadcast on CBS News "60 Minutes" on November 22.
Eighteen to 20 percent of Americans spend their last days in an intensive care unit (ICU), says Byock. He says many people are not aware there are alternatives to such expensive and prolonged death.
"Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse," Byock tells Kroft. "Most generally, it's having someone you love die badly-dying, suffering, dying connected to machines."
During the interview, Byock took Kroft through the intensive care unit at Dartmouth-Hitchcock Medical Center. "This is the way so many Americans die," he says. "It's extremely expensive. It's uncomfortable. Many times they have to be sedated so they won't reflexively pull out a tube or sometimes their hands are restrained."
Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget of the Department of Homeland Security or the Department of Education. It has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact.
The vast majority of people say they want to die at home, but 75 percent die in a hospital or nursing home.
Elliott S. Fisher, MD, MPH, of the Dartmouth Institute for Health Policy and Clinical Practice (TDI), told Kroft his research suggests that 30 percent of hospital stays in America are unnecessary. He says hospitals have become the "path of least resistance," because it's easiest for doctors to manage patients there.
Fisher pointed out that most doctors get paid based on the number of patients they see, and most hospitals get paid for the patients they admit. Add to this the fact that the government or private insurers are footing about 85 percent of all healthcare bills and it's easy to see why end-of-life care is so costly.
Says David Walker, former head of the Government Accountability Office, "We have a system where everybody wants as much as they can get, and they don't understand the true cost of what they are getting. The one thing that could bankrupt America is out-of-control health costs." Walker is now the head of the Peter G. Peterson Foundation, which advocates reducing the U.S. government's debt.
Byock believes that if more doctors were trained to speak honestly to patients and their families about end-of-life alternatives, such as hospice care, patients would be more comfortable and costs could be contained.
According to Fisher, many of the patients being aggressively treated would prefer to die at home or in hospice. "If they were given a choice, but we don't adequately give them choice," he tells Kroft.