HEALTH: About our mortality

Readers of On Health Care’s Cliff should note carefully the chart in your series that illustrates the dramatic rise in annual per capita health care costs after age 60 in the U.S. compared to other industrialized nations.

I would encourage anyone interested in this topic to read “Being Mortal” by renowned surgeon and best selling author Dr. Atul Gwande. Gwande points out that an astonishing 30 percent slice of our annual Medicare budget goes to pay for medical procedures incurred by a mere 5 percent of Medicare recipients who are in their last year of life. That represents about $150 billion spent annually. But what Gwande points out is even more troubling is that these often low percentage, expensive Hail Mary procedures — radical surgeries, costly procedures, expensive chemotherapy treatments and the like — often either shorten the patient’s life and/or make them more miserable than had they chosen palliative care and accepting nature’s inevitable course of action.

Gwande is not arguing for health care rationing, but he does seem to make the case that his own medical community needs to fully embrace open and candid conversations of death and mortality with patients equally when weighing low percentage, costly interventions that frequently shorten or ruin a patient’s remaining time. He cites many case studies including his own father in his final days. I could not help but see the parallel to my own father’s final year or so of life and wondering if some of the medical procedures he endured were of any benefit.

Gwande’s book is enlightening and it is sparking a cultural paradigm shift in our approach to end of life medical treatment. It is great reading. I would recommend it as a complement to this series on health care costs.

JON INGALLS

Coeur d’Alene