Not long ago, we received an e-mail from a listener named Timothy Price:
Why don’t health insurance companies offer bonuses to patients who are willing to forego standard end-of-life medical care? When a patient receives a terminal diagnosis, I have to believe that the healthcare companies have actuaries and data sets that would give them guidance on what the next 6-24 months of medical care would cost. For patients willing to skip this type of care my idea is for a bonus according the following formula: immediate bonus = 50% of (actuarial underwriting of standard medical care – hospice care). The patient maintains control over the optionality, but an immediate benefit opens up to them (one last grand vacation, a lasting legacy for the next generation, etc). The health insurer gets an actuarial gain and makes progress towards disincentivizing excessive consumption of health care in the final months of life. Seems like a no-brainer to the economist in me (though my sociologist wife thinks I’m completely cold-blooded).
Whether you consider Price’s idea a no-brainer or completely cold-blooded probably says a lot about how you think about end-of-life healthcare costs and, more broadly, how we handle the end of life in modern society generally. Those are the themes we poke at in this episode. Among others, you’ll hear from:
+ Ezekiel Emanuel, the physician and medical ethicist at Penn who helped put together the Affordable Care Act. More recently, Emanuel outlined his end-of-life views in an Atlantic piece called “Why I Hope to Die at 75.”
+ Uwe Reinhardt, a healthcare economist at Princeton.
+ Thomas Smith, an oncologist and cancer researcher at Johns Hopkins.
+ A University of Chicago economist named Steve Levitt.
Which of these people do you think were most enthusiastic about Timothy Price’s proposal?