AWAY GO TROUBLES DOWN THE DRAIN (via Jim Yates):

ObamaCare Dives Into End-Of-Life Debate: Medicare spends $100 billion annually on patients' final year of life. What the new bill says--and doesn't say--about treatment of the dying. (David Whelan, 07.24.09, Forbes)

Historically speaking, in the early 1980s, hospices and living wills, a type of advanced directive, became more commonplace in response to concerns about the cost of end-of-life care. The last Bush administration deliberately increased Medicare reimbursement rates for hospices to promote their use as an alternative to more expensive hospital stays. Hospices have become a big business. Chemed owns the $800 million (revenue) hospice chain Vitas. The Cincinnati company also puzzlingly owns Roto-Rooter plumbing franchises. It has one public competitor, Dallas' Odyssey, and many regional for-profit and nonprofit hospices.

Hospices, not surprisingly, support efforts in ObamaCare to promote their services. "It's a good provision," says Jon Keyserling, general counsel for the National Hospice and Palliative Care Organization in Alexandria, Va. "I've seen an inference that government doctors will be steering patients to choose less care, and that's not the intent," he says, referring to some of the controversy that's emerged around this part of the bill.

Opponents of ObamaCare argue that this five-page section of a 1,000-page bill is actually an attempt to pressure senior citizens into opting out of expensive live-saving therapy.

It brings to mind Boomsday, a 2007 satirical novel by ForbesLife editor at large Christopher Buckley, in which the government solves its fiscal problems by offering tax breaks to those who kill themselves before retirement age.

If the reform is genuinely about saving money then the reality is we need to use it to kill people rather than spend a lot of money on treating them when they're ill. Of course, if the public understood that it would oppose the bill.

Posted by Orrin Judd at July 26, 2009 8:39 AM