Not even in Congress yet & already, we're limiting care...
WH
Q She's 105 now, over 105. But at 100, the doctor had said to her, I can't do anything more unless you have a pacemaker. I said go for it, she said go for it. But the arrhythmia specialist said, no, it's too old. Her doctor said, I'm going to make an appointment, because a picture is worth a thousand words. And when the other arrhythmia specialist knew her, saw her joy of life and so on, he said, I'm going forward. So that was over five years ago. My question to you is, outside the medical criteria for prolonging life for somebody who is elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cutoff at a certain age?
THE PRESIDENT: But, look, the first thing for all of us to understand is that we actually have some choices to make about how we want to deal with our own end-of-life care. And that's one of the things, I think, that we can all promote. And this is not a big government program. This is something that each of us individually can do, is to draft and sign a living will so that we're very clear with our doctors about how we want to approach the end of life.
I don't think that we can make judgments based on people's spirit. That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people --
Q But the money might never have been there for her pacemaker or for your grandmother's hip replacement.
THE PRESIDENT: Well, and that's absolutely true. And end-of-life care is one of the most difficult, sensitive decisions we're going to have to make. I don't want bureaucracies making those decisions. But understand that those decisions are already being made in one way or another. If they're not being made under Medicare and Medicaid, they're being made by private insurers. We don't always make those decisions explicitly. We often make those decisions by just letting people run out of money or making the deductibles too high or the out-of-pocket expenses so onerous that they just can't afford the care.
And all we're suggesting -- and we're not going to solve every difficult problem in terms of end-of-life care; a lot of that is going to have to be we as a culture and as a society starting to make better decisions within our own families and for ourselves. But what we can do is make sure that at least some of the waste that exists in the system that's not making anybody's mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know, and your mom know, that you know what, maybe this isn't going to help, maybe you're better off not having the surgery, but taking the painkiller.
And those kinds of decisions between doctors and patients, and making sure that our incentives are not preventing those good decisions and that the doctors and hospitals all are aligned for patient care -- that's something we can achieve. We're not going to solve every single one of these very difficult decisions at end of life, and ultimately that's going to be between physicians and patients. But we can make real progress on this front if we work a little bit harder.
WH