Daschle Speaks

Meet the new Secretary of Health & Human Services in the Obama administration.

Daschle says Medicare should pay more for care that leads to good outcomes, and should stop paying for unnecessary or harmful treatments.

Be careful what you wish for.

He stops short of saying the U.S. should have a U.K.-style, hard-and-fast rule on cost-effectiveness. But he does say the U.S. “won’t be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective.”

Mr. Daschle, meet Dartmouth

The records of about 4.7 million Medicare patients who died between 2000 and 2003 were studied in the new Dartmouth research. The patients all had one or more of 12 chronic diseases, including cancer or heart, lung, or kidney conditions. It was estimated that almost one-third of the Medicare spending on those patients did not improve health and was therefore termed "unnecessary."

Other recent Dartmouth studies have shown that regions with the highest health care costs actually have lower-than-average outcomes and poorer quality of care in general. With about three-quarters of total US health care costs resulting from treating the chronically ill, some may argue that we needlessly sacrifice resources on end-of-life cases that could be applied to those with the chance of brighter outcomes.


and JAMA.

Medical care at the end of life consumes 10% to 12% of the total health care budget and 27% of the Medicare budget. Many people claim that increased use of hospice and advance directives and lower use of high-technology interventions for terminally ill patients will produce significant cost savings.

So . . . who wants to be the first to pull the plug on Grandma?