WASHINGTON
Two months into his term, U.S. Sen. Mark Warner has marched into the policy thicket that is health-care reform, urging a national discussion on the touchy question of how best to treat terminally ill people.
In a speech to hospital executives this week, Warner called for intensified efforts to educate individuals and families in advance about end-of-life care. With better information, many people would forgo expensive and almost-always-futile treatment for patients near death, he said.
Such measures account for more than one-fourth of Medicare payments and 10 to 12 percent of all health costs, studies suggest.
"We leave it to families to resolve these extraordinarily difficult decisions with little guidance," Warner said. "Other industrialized nations have dealt with the end-of-life issue. It's time we did as well."
Warner also backed a wide range of more conventional health-care reforms, including some that are part - at least in concept - of President Barack Obama's evolving health-care initiative.
The Obama plan was the subject of a White House forum Thursday. Warner did not attend - most invitations went to more senior lawmakers - but the former Virginia governor said he hopes to be part of the health-reform debate Obama has demanded that Congress undertake this year.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said Warner's remarks put the freshman lawmaker at "a very volatile intersection" in the health-care debate.
Caplan praised Warner for tackling a subject most political leaders try to avoid. When politicians talk about curtailing care in the context of controlling medical costs, he said, many Americans worry that "they're just trying to get me to die faster."
Warner said how and when treatment should be limited or ended as a patient approaches death is "an issue that makes us all uncomfortable." He stressed that he is not advocating a system that denies care to patients and families that want it.
Instead, he said, he wants lawyers, doctors, medical ethicists and religious leaders to collaborate on reforms that would ensure patients have thought through decisions about when and how long to pursue extraordinary treatments.
Warner's "point is well-taken. These things ought to be planned," said Laurens Sartoris, president of the Virginia Hospital & Healthcare Association.
But the line between futile end-of-life treatments and care that can significantly extend life often is hard to discern, he said. Patients and doctors alike are understandably wary of deciding too soon to curtail treatment.
Patients and families also are often influenced by cultural factors, he added. Rural residents are more likely to expect to die at home, while those who live in urban areas routinely expect to go to a hospital and receive aggressive care to the end.
Warner, 54, acknowledged that personal experience has helped shape his thinking on the issue. His mother, who now requires hospice care, has had a long and difficult struggle with Alzheimer's disease.
Caplan predicted it will take more than voluntary efforts by the medical, legal and religious communities to get most Americans to make better decisions about end-of-life care.
Most states now have provisions for living wills, and it's routine for doctors to encourage patients and families to provide detailed directives for terminal care, Caplan said. But relatively few people agree to limit life-prolonging treatments, and many change their minds when a hopeless illness or injury occurs.
When a loved one is dying, "family and friends want to feel like they did every-thing" and the health-care system encourages them to pursue every available treatment, Caplan said. Such treatments often are very profitable for hospitals, and doctors fear they'll face malpractice lawsuits if they hold back, he added.
Steffie Woolhandler, a Harvard Medical School professor and co-founder of Physicians for a National Health Program, argued that there's no evidence the end-of-life planning Warner advocated would reduce health-care costs.
Everyone should plan for end-of-life care, she said, but the key to reducing costs is replacing the private insurance plans that pay for most U.S. health care with a government-run "single-payer" health system.
"There's a tremendous amount of waste" associated with private insurance, Woolhandler said, with companies overcharging by about 13 percent nationally.
Warner co-founded the Virginia Health Care Foundation in the mid-1990s to channel private funds to boost care for uninsured Virginians. He made clear Tuesday that he wants to retain private insurers while cutting costs.
"We must ensure affordable coverage choices for all Americans not just because it is morally right, but because it is essential to making the system work," he asserted.
Warner also said he wants substantial federal investments in computerized record-keeping for doctors and hospitals. Once better record s systems are in place, the medical community must develop national standards "on what works and what does not " in caring for patients, he said.
Doctors and hospitals who follow those standards should get at least some protection from malpractice suits, Warner argued.
"I'll get whacked" by some fellow Democrats for that suggestion, he predicted. "But if you're asking the health-care system to make these dramatic changes... you've got to have the incentives in place to drive that."
Warner said he understands that the public is focused on the $600 billion price tag that Obama has put on the health-reform effort included in the federal budget unveiled last week.
But with annual health-care costs expected to nearly double, to $4.3 trillion, over the next decade, "The direction in which we are headed is simply not sustainable - either for the public sector or for private industry," Warner said.
"Failing to act will still mean cuts in health-care spending."
Dale Eisman, (703) 913-9872, dale.eisman@pilotonline.com
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Health Care is a mess
The only way to really fix this mess is to make the ELITE in this country (Congress & Senate) use the same system we the people have to use. That & get the Drug companies out of bed with the insurance companies, Let the DOCTORS decide what is necessary without fear of lawsuits or insurance companies deciding what is or is not needed.
Insurance companies are only worried about their bottom line, not about patient care. And , finally, WE THE PEOPLE NEED TO STAY INFORMED ! !
Never Give Up
Bulldog757 do not ever give up. My mother was diagnosed with cancer (lymphoma) in 1978 and given six months to a year to live. She stated that she was not ready to die and determined to live. After the initial unpleasant surgeries and sessions of radiation treatment and chemotherapy she lived with fairly good heath and was able to do what she wanted until her death in 2001 at the age of 84. I am sure that she was not always as well as she pretended to be, but she never complained and said she was grateful for the extra years she had. She only had a couple of short hospital stays in the last year and admitted herself the last time. She died two days later from congestive heart failure. We will all pray that you have the time to see your wishes come true.
vabeachnet
Where, pray tell, would you find this ideal medical system of which you speak? Which country has it? I am afraid the majority I know of have much worse systems than we do (nationalized heath doesn't work--as a family with in-laws in Britain, we know that firsthand).
And . . . you sound bitter, but if you loved someone who was being told their cancer treatment was experimental and only had a 40% chance of saving them, so the money would be spent somewhere else, you might change your mind. Esp if that person were still in his/her 30's or 40's.
Here's where government needs to stay out of our lives
The Conservatives love to yell about how the liberals want government to run our lives. What are the core values that the conservatives embrace?
Ban Gay Marriage
Make Abortions Illegal
No Euthanasia
The list goes on and on. From religion to firearms, they support the stuff that makes lots of money for the rich and they reject anything that might hurt the bottom line. Hospitals make Billions of dollars keeping people "alive" just a little bit longer. Do the math. What do you suppose it costs per day to keep someone on life support? Multiply that times the number of people and the number of days and you've got a rather large golden goose. Dignity? Suffering? A PATIENT'S rights? Don't make me laugh.
The system guarantees only one thing: Profitability. If you are looking for something resembling human compassion, you might want to try another health care system.
Al!
The "bioethics" guy was quoted as saying this cannot, at its root, be about voluntary things because families *never* volunteer to forego expensive treatments that could prolong life. It *is* about rationing, buddy. And, no, we don't have an absolute lack of choice, yet. Because people can always go overseas or even pay a hospital here out of pocket if they don't like what their insurance company says (ever hear of people holding bake sales to pay for their friend's surgery?--that is what that is all about!). However, under a one-payer system, there will be no choice nor reclama within the U.S. Only those who want to be medical tourists (and have the money) will stand a chance of getting things that are experimental or controversial!
Bulldog757
All I can say is that I am praying for you bulldog. Nothing we say can offer the consolation you need. I say that however... the government should help. You you have led a productive life and have paid into the system for years. We, productive citizens, work to pay for all of the social programs we will never participate in.All of those years paid into Social Security. Its just not fair. I have been where you are brother. I was given a life destination device that kept me alive until I could get a heart transplant. I am 42 years old. Man I can relate. I just want you to know there are others here who have no political opinion to discuss as regrards to your life. We pray for you and your family.
Rational Options vs Rationing of Options
Most here are missing the point that this is about education of options, not about rationing healthcare. Healthcare options are already rationed by the insurance industry. The more expensive your policy, the more option you may have but ultimately the decisions are not made by your Dr but by an insurance operative who has incentives (and is often pressured) to limit your access to medical treatments. Ultimately, I believe that anyone of sound mind should have the right to decide on and have access to any treatments available to extend their life. I also think education of the options and the realistic odds for both patient and family are vital.
Bioethics expert . . .
Why hire a bioethics guy for an issue that deals with insurance $$$?
He is certainly not there to *encourage* the saving of life. I believe he is only there to say it's okay to kill certain people in certain situations. They only got him to rubber stamp their financial decisions.
Universal Health Care Sucks
I'm with you Bulldog. Nobody should have to have a 'Board' decide who lives or dies. This is what awaits us in a Socialized health care system. Part of the Democrats plan to nationalize Healthcare.
My mother died of breast cancer in '91 after 14 years of fighting it. She had open access to a myriad of treatments which, I believe, prolonged her life by many years. In a world with 'Universal' health care this would not have been possible, as a 'government appointed' board would have been inefficiently handling requests for care.
Further, I lived in the UK for 4 years and experienced the Universal Health Care there. It sucks! I blame it, partially, for the deaths of my twin daughters in '92 (born prematurely). As in, they didn't even try to save them even though they were born alive and breathing. They just took them away quickly so we wouldn't see them die. In the USA, they might have had a chance. Not that I fault the individual Doctors and Nurses. I blame the system that trained them not to try because it cost too much.
Extraordinary Care For All
While Sen. Warner, who I cheered at the 2008 Dem Convention in Hampton, means well, he needs to think this issue through without any insurance company bottom lines or the like, in mind.
Encouraging patients to skip 'extraordinary, expensive end-of-life treatments' is aimed at denying such treatments to lower and middle income people--as an insurance company cost-cutting measure.
I would remind Mark, that Sen Ted Kennedy, who he and I both admire, is only alive today because of some 'extraordinary, and expensive end-of-life treatments.'
Would Mark have advised Ted to skip it, to save money?
Don't base it on yourself . . .
Bulldog, you have my sympathy. I just got through a fight with cancer myself, at age 50.
The rest of you, don't say "if it was *me* I would want to die with dignity and quickly." Ask yourself if that was your spouse or child, would you be willing to let them go because the government said it was time? Chilling, isn't it? But that is what the bioethics "expert" is saying--that *we* won't choose correctly for our own families so the government has to choose for us. Read the article carefully. That idea isn't even hidden there.
a difficult subject but a reality
My family got very upset with me becasuse I have made ALL funeral and burial arrangements myself. It's not an uncommon thing to do, but it's difficult to get people to talk about it. Heck, it's difficult to get people to talk about a will, or a medical directive, but these are things that are a fact of life, a reality, and could save so much pain for the remaining family. It is my strong opinion that every family should openly discuss this reality, instead of wondering what he or she would have wanted when they passed.
Some of you couldn't wait to jump on President Obama, Senator Warner, and all liberal/democrats in general. Death knows no political party, and I might suggest you wait and hear more about it before you all jump out of your skin. I don't think anyone will be pulling the plug on you anytime soon. Unless you have it planned that way.
Easy to discuss from a "3rd Person" point of view, but.....
Everyone posts as though this only pertains to the elderly and others. I am 45 and was diagnosed with a terminal illness 2 weeks ago. At 40, I started thinking about my own mortality. All I have ever asked for was to live long enough to see my kids all grown and successfully on their own; then I can rest peacefully. Is 10 more years asking too much? That will put me at 55, not hardly elderly. Advances in medicine and technology occur rapidly. Large scale embryonic stem cell research will soon commence. Clinical trials by the hundreds are underway. My cure could be around the corner. Nobody has the right to pull the plug on me! I have worked hard and paid into the "system", but I have my own insurance and do not need gov't assistance. I've worked hard and earned a Master's Degree. I am not a freeloader. I just want my fair share and a chance! Back off Warner!!
Surprising but....
It is kind of surprising that government run health care advocates would bring this subject up now. It is usually reserved for afterwards as a "oh, we didn't tell you?" once government care is implemented. There is much more to come on government rationing of health care but you are stuck once it is in place. It is extremely expensive in the form of taxation, poor on specialized care and let's people die to cut costs. Remember, "costs" are at the forefront of the governments mind but they sure don't want to upset illegal aliens or baby factories that abuse our system for free.
government-run "single-payer" health system.
I'm sorry, that's just plain frightening. Government run. Think about it. It's an oxymoron right off. Government run into the ground maybe.
Well said Liz!
The Government has an agenda and it is NOT the well being of the people.
You're dead-on (pardon the pun) with this one, but it permeates EVERY SINGLE facet of the Obama-Reid-Pelosi trifecta of screwing every single citizen to the best of their ability.
I'd submit to all of you that the "crisis/crises" that the media and his messiah, B Hussein, browbeat you into involuntarily repeating in conversation are from the incessant repetition, NOT from an actual crisis.
The 70s were far worse than this, but Obama and Co. will make sure we eclipse that Democratic policy disaster in short order! That is the real CRISIS today, destroying nearly every vestige of this free society, one liberty at a time! WAKE UP FOLKS!
You voted for this monster, so suck it up folks!
What do you expect when you vote into office people that have little concept or or value of life? Do you think they care any more about the old than they do the young (the unborn)?
It probably won't matter much if the liberals put an end-of-life provision into any legislation anyway. Their efforts at COMPLETELY bankrupting this country by tearing down of its morals, economy, and Constitution will kill us long before "our time"!
If it doesn't, the third-world disaster they're creating will probably cause us to shoot ourselves anyway... Hail comrade Warner! Hail comrade Obama! Hail USSA! What a shame folks just don't get it.
There should be provisions....
for people who have terminal illness that want to die on their terms which ultimately spares the doctors their time and decisions, the taxpayers and families their dollars, and the dying person their dignity and respect. We are allowed to euthanize our animals to humanely end their lives when they are terminally ill and treatment is not the best option. Why are humans required to suffer... physically, emotionally and mentally, and not be allowed to die on their terms. If I had a terminal illness and knew the end of the road was drawing near I would much rather gather my family and friends, say my goodbyes and take care of my final bits of business and die with dignity and respect then to allow it to be drawn out with the possibility of things left undone. This society really needs to explore human euthanasia - within some serious guidelines.
The body doesn't just shut down in one day.
tell that to the family of one who died from heart attack....speaking of which --- who and who will not or will this even be an option, get coronary bypass if they survive a heart attack. Hmmmmm?
For those interested in learning about the socialized medical care other countries have google Walter Williams' latest articles. There's one a couple of days ago on this very subject.
some of you who think others are making a huge leap between right-to-die issues and socialized medicine/euthansia....I can assure you, it's not a leap....it's the next step.
Yep, you voted for change and you're gonna get it.
Be careful..
I think end-of-life decisions should be available for families to consider. I myself have stipulated that I will not be kept alive by a machine, or live in an incapacitated manner. If someone has to shoot me, or put a pillow over my face, shoot me up with the same things they put dogs to sleep with, go for it. I will not live without some modicum of a quality of life.
That said, I DO NOT trust where this particular initiative is coming from. Nothing against Sen. Warner, but all citizens should be very concerned about govt desires to control health care, which are rooted in their desire to reign in costs. They gripe about insurance types having input about medical care now, with this alleged "reform", some bureaucrats may very well be making some of these kinds of health care decisions for us, outside the doctors.
It would be enlightening if the govt advocated as much discussion about all aspects of abortion procedures as they are trying to bring attention to this.