The Crushing Cost of Care

The Wall Street Journal | Janet Adamy, Tom McGinty


Photo: Patients themselves rarely make plans for dying, the period that typically costs the most. Getty images

A small percentage of challenging cases, often at the end of life, make up the great bulk of Medicare spending on hospital care. Are we anywhere close to containing the costs?

On Valentine's Day 2009, Scott Crawford, 41 years old, received the break that he thought would save his life. A surgeon at Johns Hopkins Hospital in Baltimore removed his ailing heart and put in a healthy one. The transplant was a success.

But complications put the former tire-warehouse worker in intensive care for almost a year. Surgeons removed his gall bladder, his left leg and part of a lung. And Mr. Crawford soon became one of the most expensive Americans on Medicare.

As his condition turned grave, one of his doctors questioned whether to keep treating him. Nurses reported feeling "moral distress" over his unrelenting pain. Still, medical opinion was split, and Mr. Crawford's family, with the backing of his transplant surgeon, pushed forward.

A few days before Christmas 2009, Mr. Crawford died, leaving behind a young son.

According to a Wall Street Journal analysis of Medicare data, the government spent $2.1 million on his inpatient and outpatient care in 2009. That was the fifth costliest of all Medicare beneficiaries that year and the highest among those who died by that year's end. Medicare covered Mr. Crawford's costs through federal disability insurance.

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