A Fatalistic Fate

A Plethora of Publishing

It’s been unusual, even for someone scanning the news for health and dying topics, to find so many articles and columns this week.  Maybe it’s because of the Affordable Care Act and our collective pre-occupation with health insurance.  As much as I applaud the increased access to health care the ACA provides, each of these articles screams the reality that the costs of our health care is anything BUT affordable.  From the horror stories of the long, drawn out dyings to the facts the the U.S. has an embarrassingly high infant mortality rate, a more embarrassingly high incidence of chronic illness, to the fact that we pay an exorbitent price for what we get, I see a glimmer of hope.  The more we face these issues and talk about them, the better chance we have of improving the situation.

Spending More and Getting Less for Health Care           Situational Analysis

This is a tightly packed gem of an article challenging the “American health care paradox” (or disadvantage): why do we have such abysmal health outcomes while spending so much?  I found it most interesting how our spending on health care compared with our spending on education and social services was also out of whack with other developed, industrialized countries; health care costs out-stripping the others.  What has happened is that, over the years, we (and we are part and parcel of the problems) have shifted our “resources earmarked for health toward medical care”.  In lieu of promoting health and education and opportunity we have chosen to care for illness.  “It is also hard to ignore the enormous funding and reimbursement disparities between high-tech diagnostic procedures like M.R.I.’s and intensive care on the one hand, and housing support, education and job training on the other.  It is difficult to accept all the lost potential for an inclusive and holistic approach in policy proposals and health care plans. And it becomes clearer … how even in our own lives, doctors, medicine and all the latest treatments are not the only things that keep us healthy.”  Author: Pauline W. Chen, M.D.  link below

http://well.blogs.nytimes.com/2013/11/21/spending-more-and-getting-less-for-health-care/?_r=0

Sometimes Sad to Be a Baby Boomer

I remain in absolute awe of the advancements we’ve made in science, technology, medicine, and social change.  It’s Mind Boggling all right.  So mind boggling that I’m beginning to think that our Boomer brains have become so boggled that we are now oblivious to the burdens we are becoming to our next generations.  Although the cost of our health care is but one of many burdens we’re leaving, I think it’s one that we Baby Boomers can influence in record time.  And we can do it by using the Medical Care System less.  It’s OK.  It stops most people in their tracks when I suggest this, so when you catch your breath again maybe think about it a bit.   As all of these articles say, in one way or another, the dollar AND personal costs of extended treatment for non-curable conditions is HUGE.  If we only consider that 25% of total Medicare expenditures are for treatment in the last 1-2 yrs of life, that’s a big number.  We don’t even have good data on Medicaid costs.  And, we are becoming more aware of the costs of care-giving, which are in addition to medical costs, and not typically covered by Medicare.

It’s Not All About Us

I’m no historian but I do have a hunch that we are no more greedy, aggressive, or self-centered than any other time in history.  I think the difference is that our Boomer Generation, and our surviving parents, have the means to prolong our lives with medical care never before seen in history, and we’ve been using them.  According to the United Nations Population Fund “by 2050, there will be more old people than children under the age of 15 for the first time in history.” (How in the World Will We Care for All the Elderly? from “The New Old Age – NYT” by Judith Graham).  We Boomers didn’t create more options only for ourselves though.  Our children have exercised options as well, as they continue to create alternative-becoming-not-so-alternative family constellations and seek economic opportunity far from their ‘families of origin’. A. perhaps, unintended consequence is that as parents require more assistance just to live safely our families are scattered far and wide managing competing responsibilities. Personally, I want to do everything I can to help my children flourish and I don’t want to be in a position of requiring help to live any longer than necessary.

Just Say No?

The slogan didn’t do much for the war on drugs. I even vividly remember explaining to our children, as they colored their ‘just say no to drugs’ work sheets from school, that not all drugs were bad.  Likewise, not every medical intervention need be rejected.  The problems emerge when we feel compelled to make a medical decision in the absence of complete information. Remember, the default option in our medical care system is to opt for life prolonging treatment.  What is rarely asked, and almost never answered, is “how long will this treatment prolong this life?” and, “what effects of this treatment can I expect?” and, “what will happen, in detail, if I do nothing?”.  An example:  My patient was diagnosed with Chronic Kidney Disease and treatment ensued. This is irreversible and effects every bodily system.  So, in addition to kidney failure the patient often has diabetes, high blood pressure, anemia, risk for blood clots, neuropathy, etc..  The time comes when the doctor says it’s time to start dialysis.  When I asked my patient if she asked the doctor ‘what would happen if she didn’t start dialysis?’ she answered, “He said I would die.”  Almost of a year of nightly peritoneal dialysis, unrelieved pain from blood clots in her left foot and leg, and the eventual amputation of that leg, she died.   The total time was 3 years from diagnosis to death. The cost exceeded a million dollars.  Could she have said “no more” anywhere along the trajectory?  That’s the kind of hard decision making I think we need to be considering.  As an aside, the first ‘auto-obituary video’ published by the New York Times, was that of Art Buchwald, Humor Writer. Mr Buchwald had started dialysis then chose to stop it after 11 treatments.  There are 4 videos in the series but the last one is “A Celebrity for Death”.  Mr. Buchwald also had a leg amputated.

A Lot of Information

There’s a lot to digest in these many references.  In future posts we’ll look at how to begin making these kinds of decisions.  As a starter for that I suggest the article in the New York Times Special Section “How Doctors Die”.

 True Cost of End of Life Care

http://americablog.com/2013/11/true-cost-end-life-care.html

The New York Times Special Section:  The New Math of Health Care

http://www.nytimes.com/business/businessspecial5/index.html     Articles Include:  “How Doctors Die”;  “You Planned Your Retirement, Then You Get the Health Bill”;  “Caring For Aging Parents, Even From A Distance”;  “Planning for a Future in the Face of Terminal Illness”;  “Medicaid Help Without Falling Into Poverty”.