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BOB ABERNETHY, anchor: Now, a wrenching question about medical care for the elderly. More and more high technology can prolong life. But usually for only a short time, at enormous cost. Should that money be spent elsewhere? Who should decide? Betty Rollin has our report.
BETTY ROLLIN: Robert Messineo, who is 65, almost died two different times when his heart stopped working. What keeps him alive until he receives a heart transplant is a left ventricular assist device, called LVAD.
ROBERT MESSINEO (LVAD patient): I've been saved a number of times and I have seven grandchildren, a wonderful family, and a lot to live for.
ROLLIN: Mr. Messineo is understandably grateful for the technology and, understandably, not thinking about its cost.
Mr. MESSINEO: How that is supported by society, I'm not really sure, but from my personal view it's a miracle and it's really important.
ROLLIN: An LVAD implant costs about $60,000 per device, plus an additional $150,000 in hospitalization. Currently, Medicare covers the LVAD only for patients waiting for heart transplants. But it may extend coverage for others as well -- which would mean several thousand patients a year would be eligible, bringing the yearly price tag for the implants to half a billion dollars. LVAD is just one of several expensive technologies that would raise America's 1.4-trillion-dollar healthcare budget even higher.
(to Dr. Tunis): And how effective is the device?
Dr. SEAN TUNIS (Center for Medicare and Medicaid Services): The vast majority of people die within two years, and about half of that time -- the people who have the pump -- they actually spend hospitalized.
Dr. DIANE MEIER (Mt. Sinai Hospital): Much of the high technology that we use may prolong life by hours to days. But, life in a coma, life dependent on a ventilator with absolutely no hope of leaving the hospital alive and going home -- the message to the family is why would they be doing this if they didn't think it was helpful? And yet, the patient doesn't understand that the doctor knows this is futile -- but feels helpless to do anything that would stop it.
We don't want to be the bearers of bad news to our patients. We want to be cheerleaders on the side of more life. Patients and families facing serious illness often don't want to discuss the inevitable.
ROLLIN: With an increasingly older population, "the inevitable"-- dying -- and its prolongation -- has become more and more of an issue.
Twenty-eight percent of Medicare's budget is spent on reimbursements to people over the age of 65 in their last year of life. The bulk is spent in the last 30 days. That's about 75 billion dollars, an amount that could go a long way in covering the 41 million Americans who are uninsured.
Can society afford to continue this kind of spending? And if not, is rationing a solution?
DANIEL CALLAHAN (The Hastings Center): We will have to ration with the elderly because the elderly has the only program in this country that provides guaranteed healthcare. I would say the first obligation of medicine is to help the young people become old people, but not indefinitely to help old people to become still older and go on and on.
ROLLIN: Dr. Meier doesn't think age should be the criterion of rationing.
BETTY ROLLIN: Robert Messineo, who is 65, almost died two different times when his heart stopped working. What keeps him alive until he receives a heart transplant is a left ventricular assist device, called LVAD.
ROBERT MESSINEO (LVAD patient): I've been saved a number of times and I have seven grandchildren, a wonderful family, and a lot to live for.ROLLIN: Mr. Messineo is understandably grateful for the technology and, understandably, not thinking about its cost.
Mr. MESSINEO: How that is supported by society, I'm not really sure, but from my personal view it's a miracle and it's really important.
ROLLIN: An LVAD implant costs about $60,000 per device, plus an additional $150,000 in hospitalization. Currently, Medicare covers the LVAD only for patients waiting for heart transplants. But it may extend coverage for others as well -- which would mean several thousand patients a year would be eligible, bringing the yearly price tag for the implants to half a billion dollars. LVAD is just one of several expensive technologies that would raise America's 1.4-trillion-dollar healthcare budget even higher.
(to Dr. Tunis): And how effective is the device?
Dr. SEAN TUNIS (Center for Medicare and Medicaid Services): The vast majority of people die within two years, and about half of that time -- the people who have the pump -- they actually spend hospitalized.Dr. DIANE MEIER (Mt. Sinai Hospital): Much of the high technology that we use may prolong life by hours to days. But, life in a coma, life dependent on a ventilator with absolutely no hope of leaving the hospital alive and going home -- the message to the family is why would they be doing this if they didn't think it was helpful? And yet, the patient doesn't understand that the doctor knows this is futile -- but feels helpless to do anything that would stop it.
We don't want to be the bearers of bad news to our patients. We want to be cheerleaders on the side of more life. Patients and families facing serious illness often don't want to discuss the inevitable.
ROLLIN: With an increasingly older population, "the inevitable"-- dying -- and its prolongation -- has become more and more of an issue.
Twenty-eight percent of Medicare's budget is spent on reimbursements to people over the age of 65 in their last year of life. The bulk is spent in the last 30 days. That's about 75 billion dollars, an amount that could go a long way in covering the 41 million Americans who are uninsured.
Can society afford to continue this kind of spending? And if not, is rationing a solution?
DANIEL CALLAHAN (The Hastings Center): We will have to ration with the elderly because the elderly has the only program in this country that provides guaranteed healthcare. I would say the first obligation of medicine is to help the young people become old people, but not indefinitely to help old people to become still older and go on and on.ROLLIN: Dr. Meier doesn't think age should be the criterion of rationing.
Dr. LEWIS GOLDFRANK (Bellevue Hospital, New York): Often the patient is confused. The patient is tied down. Sometimes it's so difficult for the human being that we have to do things that are painful.
Dr. MEIER: Families particularly living with orthodoxy in their religion who turn to their religious leaders for advice are told that their life is not their own and that their obligation is to advocate for maximum possible technological life prolongation because their religion requires it of them.
Mr. CALLAHAN: We are going to have to spend much more effort instead of developing expensive technologies -- learning how to get people to take care of themselves better and really change their lifestyles.
