• Gregory R. Piche'
    3144 Newton Street
    Denver, CO 80211

Areas of Practice

  • Healthcare Consulting
    Peer Review Proceedings
    Hospital/Physician Relationships
    Medicare/Medicaid Audits




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Greg Piche

Thank you Charles for your thoughtful comment. In the present environment the rationing of care, useless or otherwise, is a highly sensitive issue. My point is that to some extent Medicare procedures are already rationed and that if someone after an appropriate presentation of options and choices to elect treatment to pursue medically reasonable, covered procedures, even though unlikely of success, they ought to be able to do so. I believe that most people presented with the array of options will decide to forego costly "useless" procedures and choose to die with dignity rather than on a ventilator. This should help peel back a substantial part of the $50 billion dollar month end of life care tab.

Charles Falls

I enjoyed reading this, but am not sure I understand your position. You claim that people should have the right to continue with "useless" care, but then explain how this care costs the country $50 billion per year.

Are you saying that the government's involvement will only add to the useless care, thus the growing cost? If so, then "death panels" should really be called "life panels" because they will be lengthening life, not shortening it.

The point of Obama's plan is NOT to lengthen lives when doing so is all but impossible, but to actually take away the incentive for doctors to promote "doing everything" (ie, spending money) when it's really clear the outcome is not going to be good (and the money will be wasted). This will save the $50 billion since the cost of counseling people to simply deal with dying is nothing compared to the cost of treatments that are worthless at the end of a dying person's life. The counseling is simply afforded so people do not have to feel they are making the decision alone or without good information. It shows compassion during those difficult times.

Obama's plan is a major change in healthcare, and it's about time. It calls for doctors and hospitals to be paid for success rather than services, thus the focus on prevention and planning over testing and operating. Extending the life of someone who is on death's door for one to four months is not success. It may make the doctors and hospital some money, but it does nothing for the patient and his/her family except prolong the suffering. Heck, we treat our pets better than that.

With Obama's plan, doctors will NOT want to give people tests or procedures for things unless it's absolutely necessary to improve the patient's health because each test will remove money from the pool of money the doctors will receive to care for those in their service area.

Yes, this plan will mean that doctors will make more money by doing less.

Ah, but doctors also do not want to do the wrong thing by not recommending tests or procedures when necessary because if a patient gets worse, it will cost the doctor even more money because they'll have to offer the patient more advanced healthcare later.

Obama's plan is about giving doctors financial incentives to do effective work to keep people healthy, and punishing them financially when they don't. They will be rewarded for generating healthy results rather than generating numerous procedures and tests.

Regarding end of life decisions, people should not be allowed to ask a doctor to do everything possible ("whatever the cost" in most cases) when they are not footing the bill. Yes, we should have compassion and care for those we can help. But conducting tests and procedures for people on their death beds only makes sense when it's understood that there's a decent chance for recovery. When there is a chance for recovery, we should offer all the help our medical world can give -- regardless of the patient's financial situation. But when someone's going to die, we should help them learn to deal with it with dignity (like you said).

I have first hand experience with this and wrote about it at this link You'll see that many people, but not all, will die with grace and dignity but that others will demand everything, even though the cost of such greed gets thrust upon everyone else.

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