File spoon-archives/marxism-international.archive/marxism-international_1997/97-01-31.063, message 60


Date: Thu, 30 Jan 1997 20:06:56 -0500 (EST)
From: louisgodena-AT-ids.net (Louis R Godena)
Subject: M-I: Hospice patients living too long: A problem of capitalist health care



HEW Secretary Donna Shalala threatened to cut "substantially" government aid
to hospice providers because their terminal patients are responding too well
to the program of in-home health care,  and are not dying as quickly as
expected.

Medicare generally pays for the last six months for visits by hospice nurses
during the last six months of a patient's life.    The cost to the
government is about one-fourth of that of skilled nursing home care and less
than *10%* of that of hospitalization.    Yet the total bill for the hospice
program came to nearly 2 billion dollars last year. 
Under the hospice program,  the terminally ill patient is entitled to one
paid visit per week by a health professional -- usually a nurse practitioner
-- and daily visits from a  "home care specialist" to assist in the daily
routines of cooking,  cleaning,  bathing and the like.   

The problem of course is that patients are responding so well to the
personal care and attention they receive in their last months that they are
finding new reasons --- and new strength -- to go on living,  often months
and even years beyond their expected departure date.    This is creating
problems not only for Medicare;  the private insurance industry which has
long eyed this sector of the health care industry as a candidate ripe for
privatization is also growing increasingly concerned.    Recently,  Barry
Haller of Prudential HealthCare Systems (and a member of Hilary Clinton's
ill-starred health care panel) put it without squeamishness:  "We must be
careful," he intoned, "not to pamper the terminally ill.     Our task should
be to make their final time as comfortable as possible as economically as
possible".    

What does a humane person due with a society where horse's asses like Barry
Haller and Donna Shalala are allowed to consign an entire generation of
suffering human beings to the oblivion of some corporate bottom line? 

Where's the Shining Path when you need them?

Louis Godena     



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