QUALITY/POLICY: Gerald Ford–the poster child for what’s wrong with health care

Gerald Ford died last night aged 93. By any standards he had a great life. He was a moderate Republican in the House for many years, and then a stop-gap President after Nixon, famous mostly for pardoning Nixon who hadn’t yet been charged with a crime. And then lived on for nearly another 30 years. The American dream of the College jock becoming President and achieving great wealth and happiness—and people liked him!

But it’s the manner of his death that I think is very important. Just two months ago in a “discussion” I had with David Gratzer of the Manhattan Institute, I raised the point that Ford had not one but two angioplasties at the Mayo Clinic—and that as he was likely to die soon anyway that money would have been better spent on pre-natal care for an uninsured woman who was featured on ABCNews that week.

David Cutler recently estimated that adding an extra year of life for the elderly cost $145,000.

So consider Ford’s last few months of life. He was admitted to hospital last January for pneumonia. Then spent much of July in hospital in Vail; then went to the Mayo Clinic for not one but two angioplasties in August. Then went back into hospital in California in October, and now has died in December. All that time he was obviously going to die within a year or so, and all that time he was at least 92 years old.

My guess is that over the last 12 months of his life well in excess of $100,000 was spent on his health care. And that money probably extended his life by three months at most. Now for all we know they may have been the most wonderful three months ever for him and his family, but I’m inclined to think that if he’d died in the summer, his family would have been equally fine with it, and the nation wouldn’t have felt any differently about him. But the cost of extending life an extra year in this type of case is probably around $400,000.

How can that possibly have been money worth spending? The answer is that it cannot have been. And that is where the money is in our system which could pay for all the pre-natal care for uninsured mums, immunizations for sick kids, and procedures for uninsured 50 year olds that we “can’t afford.”  And frankly it’s probably better and more humane care to provide palliative care at home than to put sick old people through yet more invasive and painful procedures.

So the sooner we start having that conversation the better. And if that conversation comes out of Gerald Ford’s death, then at least that spending on the last months of his life might have done some good.

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