Are Americans Overtreated to Death by the Medical Establishment?

A truly valuable article from the AP today "Americans are treated, and overtreated, to death".  The article stares down a hard question - When do we stop focusing on a cure and start caring about how we die?

The statistics are disturbing:

Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.

More than 80 percent of people who die in the United States have a long, progressive illness such as cancer, heart failure or Alzheimer's disease.

More than 80 percent of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health care trends.

Yet the numbers show that's not what is happening:

_The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.

_Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

Do we want to tell people they can't be treated for their disease because .... (fill in the reason - money, age, citizenship, whatever?).  I don't think so.  However, what is missing from the discussion about terminal disease is how do you care for it as opposed to how do you cure it, because there may not be a cure.  Death is part of life - harsh and unwanted and soul-destroying as it may be, it is and always will be the end.

The article suggest that an answer to all of these disturbing questions may start in a conversation - a real back and forth dialog with all parties being fully informed - of what it means to battle a disease or care for it.  

So where do you go to have that dialog? In a conversation I had with David J. Shulkin, MD, Chief Operating Officer and President-elect, Morristown Memorial Hospital a few weeks ago he suggest patient message boards.  He believes that patients need to be active participants in their own health care, and part of that is leveraging the experience of other dealing with the disease is addressing the "cure" v. "care" question.  

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User's Guide to Health Care Reform

AARP has put out a comprehensive and user friendly Guide to Health Care Reform that everyone should take a look at.  Regardless of what you think about the new health care legislation, the fact is that it will effect you - as an employer, a parent, a student, a worker or a retiree.  The reality of the health care legislation is further clouded by hype and various effective dates over the next 10 years.

So grab a cup of coffee, tea or water and skim through the User Guide.  Among lots of other useful information, you will find Five Things in the Law That May Surprise You;  and answers to questions if you are one of the 45 million Americans currently on Medicare.  The Guide is a "Must Read" and I encourage everyone to make time to become informed.

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Consider Becoming an Organ Donor in New Jersey

 April is Donate Life Month and New Jersey is asking residents to consider becoming organ donors.  

National “Donate Life Month” is the perfect time to consider the difference you can make in the lives of others through organ donation,” said Health and Senior Services Commissioner Alaigh. “I urge all residents to register as organ donors. Just one person can make a difference in as many as 50 lives. The gift of life is truly the greatest gift of all.”

Nationally, there are more than 106,000 people—including nearly 4,600 New Jersey residents—on a waiting list to receive a life-saving organ transplants, according to the New Jersey Sharing Network.

Becoming an organ donor in New Jersey is a simple as a click of a mouse - you can find out more information at the online at the NJ Motor Vehicle Commission Organ Donor page, or simply download the organ donor form.

You can get more information on Organ Donation at


Quick Highlights of Health Care Legislation

The new health care legislation is massive - over 2000 pages.  It will be years before many questions are answered, but has an immediate effect on all of us.  I got this summary of quick highlights from Steven Kaplan, CPA, JD, LL.M at Sax Macy, Fromm & Co. and thought it did a great job of boiling down to the key points:

Penalty for remaining uninsured.
After December 31, 2013, taxpayers would have to maintain minimum coverage or pay a penalty.

Employer responsibilities.
After December 31, 2013, an employer that employs at least 50 full-time employees and does not offer health insurance coverage would have to pay a penalty.

Excise tax on high-cost employer-sponsored health coverage.
After December 31, 2017, the bill would place a 40% nondeductible excise tax on insurance companies for any health coverage plan to the extent that the annual premium exceeds $10,200 for single coverage and $27,500 for family coverage.

New employer reporting responsibilities.
After December 31, 2010, employers would have to disclose the value of the benefit for insurance coverage on the employee's W-2.

Additional hospital insurance tax (HI) for high-wage workers.
After December 31, 2012, the HI tax rate would be increased by 0.9 percentage points on an individual taxpayer earning over $200,000 ($250,000 for married couples filing jointly); these figures are not indexed. The current rate is 1.45%.

Surtax on unearned income.
After December 31, 2012, a 3.8% surtax would be placed on net investment income of a taxpayer earning over $200,000 ($250,000 for a joint return). Net investment income would be interest, dividends, royalties, rents, gross income from a trade or business involving passive activities, and net gain from disposition of property (other than property held in a trade or business).

Limit on health FSA contributions.
After December 31, 2012, contributions to health flexible spending accounts would be limited to $2,500 per year.

Increased tax on nonqualifying HSA or Archer MSA distributions.
After December 31, 2010, the additional tax for HSA withdrawals would be increased from 10% to 20% and for Archer MSA withdrawals would be increased from 15% to 20%. This applies to withdrawals for nonqualified medical expenses.

Modified threshold for claiming medical itemized deductions.
After December 31, 2012, the threshold for claiming an itemized deduction for medical expenses would be increased from 7.5% to 10% for those under age 65.

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