A true story, with changes made to protect privacy. An 89-year-old man with dementia, a heart condition, and other serious medical conditions fell in his Arizona apartment and broke his hip. His children, wanting the best possible care, arranged for him to be air-lifted to New York. There, the orthopaedic surgeon advised them that the chance of their father surviving hip surgery was very low, but he would do as the family wished. The man’s three children could not agree. Two would have avoided the surgery, but a third felt very strongly that everything that could be done for the father should be done. The other siblings, out of guilt and respect for the third, acceded. The surgery took place, and the father spent three days in the ICU before his heart gave out.
Here’s the terrible and hard-hearted question I pose: If the costs of this procedure and hospitalization had not been covered by Medicare, would the man’s children have proceeded along the chosen path? I am guessing not. I don’t know the total bill incurred, but it was certainly in the range of tens of thousands of dollars.
In the US, we don’t have a good societal process for making these decisions. In the United Kingdom, though, they do, as reported by Bob Wachter in a recent blog post. Here are some excerpts:
