Issue: Determining who gets care and who does not.
Fear: Rationing of health care will disproportionately affect the elderly and terminally ill.
Reality: In determining who will receive care and who won’t, medical professionals will be encouraged to apply the QALY system (Quality-Adjusted Life-Years), a statistical analysis that uses cost of treatment and remaining quality years of life to reach a conclusion. There is great concern that assessments such as these will diminish the importance of the remaining days and years in the lives of the elderly and, as Morris says, "condemn them to infirmity, pain and an earlier death than might otherwise be their fate."

Issue: Reducing wasteful spending at end of life.
Fear: The plug will get pulled on grandma.
Reality: One of the most emotionally charged issues concerning health care reform has centered on the provision authorizing Medicare to pay doctors for voluntary end-of-life counseling about living wills, hospice care and other issues. This is, in theory, an excellent idea since research has shown that providing such counseling improves quality of life for both patients and family members, but, as Morris points out, in practice this may not be as successful as proponents might hope. And the big question is, does government even belong in the business of personal choice and legal advice?

Morris notes that there is an increasing focus on end-of-life care for the elderly. As we’ve written previously in Daily Health News (see November 18, 2008, issue), there is more and more evidence that quantity of care doesn’t correlate with quality of care -- The Dartmouth Atlas of Care study found that regions where older patients received costlier and more aggressive care in the last few years of life did not have lower mortality. In fact, in some cases, patients even die slightly sooner, on average.

However, Morris cautions that in the hands of a cost-conscious medical administrative board within the government, this could be a slippery slope. Inevitably this will lead to situations where an individual is unable to get health care that he/she would benefit from because broad rules are being applied. Of course, the removal of the end-of-life counseling from the bill makes no difference anyway, Morris adds. "The incentive to economize and the need to dole out scarce resources will remain and will serve to curb end-of-life treatment for the elderly."

Dick Morris’s Blueprint for Change

"Taken together, President Obama’s decision to cut the Medicare budget and to expand insurance coverage to 50 million new patients without any new doctors or nurses will significantly impact health care for those 80% who are satisfied with their current health care coverage... and not for the better. The high cost of medical care should not be accepted as a fact of life. Truly effective health care reform must lower costs, trim unnecessary spending and address tort reform," says Morris. "The biggest danger is that Congress will be motivated to pass something in order to be able to say they did it -- but in rushing it through will end up with a pile of compromises that do nothing to improve health care. In that case, nobody wins."