Closure.org Blog

By Jonathan Weinkle, MD

Joe Klein has spent most of his adult life on the presidential campaign trail, reporting for Time magazine on presidential politics.  He asks hard questions and provides sharp analysis of both Democratic and Republican candidates.  One wonders if, in 2012, he will have a new, difficult question to ask, born of his recent personal experiences.

Klein’s parents recently died, each of them after the long series of illnesses that typifies how older Americans die in this day and age.  His mother succumbed to pneumonia in the end, and his father to kidney failure.  In a recently published Time cover story and accompanying video, he discusses the experience.

Nothing Klein says will be news to anyone who has recently experienced the death of an older loved one.  Procedures were done, like repeated lab draws and placement of a feeding tube, that did not add length of life, but did add to the burden of suffering.  The feeding tube was placed because when the doctor in Pennsylvania called Klein in Chuck Grassley’s kitchen in Iowa and said, “We have to put in a feeding tube or we’ll lose her,” he felt like he didn’t really have a choice at that time.  The whole truth of how soon Mrs. Klein was likely to die didn’t come out until after the time was already in.

Nor will it be news that once the elder Kleins were moved to a Geisinger-owned nursing home, the team-based, outcomes-oriented approach to care in that system allowed Joe Klein to be a part of the decision-making process, and allowed him to honor his parents’ wishes for a peaceful death when the time came.  He was treated for the first time in his memory to candor from the doctors.  They spent the time they had left on goodbyes, not on additional trips to specialists and hospitals.

Even Klein’s conclusion that fee-for-service Medicare reimbursement, where doctors get paid according to each and every procedure they bill for, is the reason for so much unnecessary, unhelpful, burdensome care, is not new.  The correlation between fee-for-service and the quantity (not quality) of care provided is a common theme in healthcare for the last 30+ years.  The one procedure not being reimbursed is any type of conversation between providers and patients (or families) about values, preferences, and decision-making, either in advance or in the moment.  The fee for that service was stricken from the Affordable Care Act, even though Republicans and Democrats alike, in both the House and Senate, had included it in their preliminary versions of the bill in 2009.

What is new is that it is Joe Klein raising these issues.  Joe Klein, who knows he has the candidates’ ear, can ask in a voice that candidates will have to hear, “What will you do to ensure that our healthcare system treats elderly, dying Americans the way they want to be treated, instead of using taxpayer-provided Medicare money to pay for care that doesn’t benefit the taxpayer or the patient?  What will you do to reduce the burden of suffering on people like my parents in the last days of their lives?  What will you do to ensure that end-of-life decisions can be made with a clear head and full information about the prognosis and all of the options?”

Here’s hoping that Joe Klein exercises the same kind of candor on the campaign trail that he found at Geisinger.