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Carnegie Mellon professor urges changes to end-of-life care

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Thursday, Sept. 27, 2012, 12:01 a.m.

The $15 trillion national debt might be considered the culprit in the nation's economic woes, but the country has a bigger challenge in cutting the estimated $75 trillion in promised Medicare and Medicaid benefits “in the most humane way,” a Carnegie Mellon University economist said Wednesday.

“The promised benefits are far more than we can pay. We have to reduce the amount of benefits ... and try to do it in the most humane way,” said Allan H. Meltzer, a political economy professor at the Oakland school, in a speech to a St. Vincent College audience.

A different approach must be taken to end-of-life care in order to put the government on a path to reduce the amount of unfunded liabilities of Medicare and Medicaid, which are estimated to range as high as $75 trillion, Meltzer told more than 180 students and faculty at the Fred M. Rogers Center on the Unity campus.

Paying for care

Patients in the later stages of life should have access to the care they want, but only if they are willing to pay for the treatment. That treatment should be priced at a sliding scale, based on the patient's income, Meltzer said. Faced with those “serious choices,” patients may opt to “die in peace and have hospice care,” Meltzer said.

Such measures are necessary because more than 50 percent of Medicare costs are incurred in the last six months of a patient's life, Meltzer said. At that point, the health care decisions should be left to the patient and his or her doctor, not insurance companies and bureaucrats. Under President Obama's Affordable Care Act, a panel of experts — the so-called death panels — would make those decisions.

Meltzer also took a shot at Obama's national health care plan, saying that while bringing health insurance coverage to 32 million Americans, the administration failed to take steps to create any more primary-care physicians. Thus, instead of waiting for care in an emergency room, Meltzer said they will be waiting in a physician's office and most likely be seen by a nurse practitioner because of the shortage of family doctors. To solve that problem, the health care delivery system has to be able to pay primary-care physicians more while paying specialists less.

Meltzer, a speaker in St. Vincent's Alex G. McKenna Economic Education Series, criticized the Obama administration's handling of the economy, saying the policy “has created uncertainty,” so much so that investors are sitting on “billions of dollars of capital” waiting to calculate the cost of health care, energy and taxes.

Meltzer, who has been a visiting professor at Harvard and served on the President's Council of Economic Advisers, said the economy is in a slow recovery and will continue on that path. He expressed concerns about inflation, particularly if the Federal Reserve releases more money.

Political forecast

If Obama wins another term, Meltzer said he sees a continuation of the political stalemate in Washington. If Republican Mitt Romney wins, it will take time for his policies to be implemented.

Meltzer said he believes that Romney can use lessons from his success in the business world to improve the economy. Romney has shown he can be a leader and can compromise to accomplish goals.

“That's two places where the president has been very weak,” Meltzer said.

Joe Napsha is a staff writer for Trib Total Media. He can be reached at 724-836-3562 or

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