If we moved to Florida fulltime and I would die there, I would see about 46 doctors, mainly specialists, end up in intensive care for more than 6 days and have a 27% chance of dying there, and it would cost about $23,000. If we went to Portland, Ore the doctor visits would drop to 18 times, I’d have a 13% chance of dying in ICU and the tab would be about $14,000. It would be most expensive if we moved to Manhattan, $35,838 and cheapest if we moved to Wichita Falls, TX, $10,913; perhaps they’d just shoot me. If you look at Medicare $27% of their budget goes to patient care in their final year.
One of the main reasons for this is various is doctor’s willingness to talk to patients about end of life care. Most of us old geezers are ready to go, but if we haven’t made prearrangements our kids are not willing to pull the plug or just let us go home and die. Oregon seems to be the most enlightened in listening to old folk and their wishes. [This all comes from a USA article a bit ago.]
Daniel Callahan and Sherwin Nuland writing for the New Republic tell of our unrealistic picture of contemporary medicine. In recent times there has been relatively little progress made in finding cures for major lethal illnesses, i.e. cancer, heart disease and stroke. What we have done instead is extend the lives of the very sick. It seems to me we have our priorities wrong.
These two writers recommend a revolution in practicing medicine. In essence they believe medicine should quit waging war on death and work at bringing up life expectancy to the 80’s. Most radically they say our health system should make children our number one priority in health, adults the 2nd priority and the lowest priority to those over 80. They are both over 80.
To my way of thinking, they way we have gotten to these misplaced priorities we now have in contrast to those recommended by Callahan and Nuland is because we have a profit based medical system. Old folk have more money that babies, so we get the best care.
For me this is just one more argument for government based health care, one that places the priorities that the New Republic writers advocate. I believe if you look at those countries that have socialized medicine this is born out, though I have not done that research yet.
Makes me think of my old buddy from the Cambridge church, Doris Axt, who lived to 99 I think and kept saying, “What on earth am I still doing here.” Or more poignantly, my parents who took a long and difficult time dying and would have been very happy to move on earlier than they did. And, I think most of us feel that way. We need a health care system that reflects those values and not just the values of the bottom line.
[It’s a rainy day so I’m blogging like mad instead of golfing or writing the sermon for next Sunday.]
As a society is very weird about death. This natural, INEVITABLE part of life is treated as something to be avoided at all costs, at all ages. It's difficult to even bring it up in our culture, just try bringing up 'what if' scenarios with loved ones and quickly discover how taboo it is to even talk about it.
ReplyDeleteIn healthcare we would do well to focus more on illness prevention (not scans but true long-term prevention, as in nutrition exercise etc.) and less on devoting resources toward death postponement.