The Bosque Boys

Farmer
I have not looked at any of the proposed legislation with regard to whether a "death panel" is implied.

I would suggest, however, that this function by whatever name is inescapable. We can not sustain the current level of medical expenditure and End of Life Care is a huge part of that expenditure. Someone will have to make decisions with regard to rationing the care. I am skeptical as to whether enlightened conversations between physician and patient/patient family will suffice to manage the prolonging life vs extending death ethical challenge

Photognome:

I agree. Rationing is an essential element of any solution. The current regime of end-of-life care is simply not sustainable. It is no wonder that no politician is willing to address this reality.

It is the great unstated daunting challenge to any real reform.

As I have hinted before, this may be the reason socialized medicine is really the only solution (as much as I hate to say that). Through bureaucratic inefficiency, we will get indirect rationing--like we see in other socialized systems.

What do you think?

Farmer;
I do not have a clear expectation as to how a "socialized medicine" model will address rationing of end of life care decisions. I would expect bureaucratic delays of decision making which would likely include delay of appropriate care past the window of opportunity. I do need to point out that these delays are already commonplace - Appeals of "not medically necessary" decisions are often successful but the treatment is less effective because of delays.
On the other hand a lot of care is approved in situations in which the science says there is no reason to expect it to help the patient.
Back to end of life care challenge. I do not think that any form of bureaucratic rationing (e.g. "death panels") can address this - the process is totally unacceptable to the patient, family, physician and public at large. I do not think there is any quick solution. We as consumers and recipients of health care/medical interventions do need to come to grips with the reality of death and the process of dying. Health care (financing) reform debates include a lot of discussion about "choice" - How often does the education and conversation needed for an informed choice regarding end of life care take place?
Can we turn the conversation away from How much $ is this life worth?
to
Is it worth it to you as a patient/family to go through all of these interventions in order to get the "best case" outcome, or the “most likely" outcome?