Fools Gold

I have a guest post along with Amy Abernethy at Health Affairs blog today. The story that Atul Gawande beautifully told in his New Yorker piece yesterday can easily lead to someone concluding 'lets just stop futile care at the end of life' and that will certainly address over-spending in our health care system. However, we view a focus on seeking to reduce end-of-life (EOL) spending only as the primary means to achieve great savings in the health care system as 'fools gold' in that is not likely to produce the savings that seem possible from such an approach. It is much more difficult to prospectively identify cases in which care is futile than it is to lament that such care was futile after the fact. Instead, we need a more general increase in asking the question, 'is this care worth it?' across the entire life course, and not just at EOL. There are technical issues in beginning to do this, but the biggest challenge will be for our culture to begin to honestly tussle with these very difficult questions.

Update: Atul Gawande on NPR fresh air talking about his article.