With so much evidence of wasteful and even harmful treatment, shouldn’t we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers? Sadly, we are very far from this goal. A cynic would argue that this can’t happen because children can’t vote (even if their parents can), whereas members of AARP and the American Medical Association not only vote but can also hire lobbyists to keep the money flowing.
One thing’s for sure: Our health care system has failed. Generational spending wars loom on the horizon. Rationing of health care is imminent. But given the political inertia, we could soon find ourselves in a triage situation in which there is no time or money to create medical-review boards to ponder cost-containment issues or rationing schemes. We’ll be forced to implement quick-and-dirty rules based on something simple, sensible and easily verifiable. Like age. As in: No federal funds to be spent on intensive-care medicine for anyone over 85.
I am not, of course, talking about euthanasia. I’m just wondering why the nation continues incurring enormous debt to pay for bypass surgery and titanium-knee replacements for octogenarians and nonagenarians, when for just a small fraction of those costs we could provide children with preventive health care and nutrition. Eight million children have no health insurance, but their parents pay 3 percent of their salaries to Medicare to make sure that seniors get the very best money can buy in prescription drugs for everything from restless leg syndrome to erectile dysfunction, scooters and end-of-life intensive care.
I’m remembering a parishoner, a lady of 100, who spent the better part of a year lobbying her doctor and Medicare to get knee replacement in 1995. A number of us in the community (in WV) filed statements of our belief that she would benefit from and make “use” of this, since the only real obstacle to her independence and mobility was the near-immobility of the knee in question. Finally, the approval came through.
She lived three more years, almost all of it living independently and enjoying her family and community. Was that enough to justify the expense? However you calculate that, i’m not seeing in this fellow’s analysis reason to favor putting more of a thumb on the scale against providing knees to centenarians when it can be shown usable. He seems to think that at about 75 you just don’t get them so “the right people” can get care. And they tell us to shut up about death panels. . .
My wife and I have been involved in elder-care since the early nineteen nineties. First it was with her mother who lived with us for about six years until she required 24-7 care and then we interfaced with doctors and nursing home employees in order to ensure that her needs were being met and that she wasn’t being “whare housed” in elder care facilties.
Shortly after my mother-in-law passed at 95 years of age, my 92 year old mother was incarcerated in an elder-care facility by the State of New York. She went from being a free American citizen to being an inmate in a the blink-of-an-eye.
She went from being in charge of her own house to being an inmate with a security anklet on her leg that rang an alarm every time she neared an exit to the elder-care facility. She was essentially incarcerated in that facility for the simple crime of growing old and having the officialdom of the state deciding to take her freedom from her for having committed that crime.
She is still there. She is now over 100 years of age. When she entered the facility she could walk around using handrails when she chose to do so. The gave her a ‘walker’ and she was able to move all over the place. She was a bundle of energy. Then they encouraged her to use a wheel chair, although she really didn’t need a wheel chair, and she moved around with energy in the chair. A good deal of her energy came from her feeling that she was ‘trapped for life’ in the elder-care facility.
She used to frequently say to me, “I am going to die here, aren’t I.” I was at a loss for words. She was right. She had been for all intents and purposes ‘sent to prison’ for the crime of growing old.
My mother is now 100 years old and has lost all hope of ever being ‘her own person’ ever again during her mortal life.
‘He seems to think that at about 75 you just don’t get them so “the right people†can get care”
Well, in point of fact that is the way that Europe works. At 50, no dialysis, at 60 no back/knee operations. The way it was explained to me is that the taxpayer has a right to fund only those elective operations that will result in the patient also being a taxpayer and a contributing member of society. Those who are no longer paying taxes are not entitled to the same list of procedures to which taxpayers are entitled.
If you want lower costs, it is necessary to have limits on care. The new knee for the 100 year old lady would have paid for several hundred uninsured folk to get their BP and diabetes treated.
My own feeling is that society should have a safety net for emergency care (broken hips and appendectomies) extended to everybody. If somebody wishes an elective procedure, whose purpose is simpy comfort, well there are a lot of uninsured folk who are limping to work and pay their medicare taxes and don’t see a dime of it.
Europe belives that folks who do not contribute into the system, but desire elective items, should save up the money and pay for it themselves. If you do medical tourism to India where there is no malpractice liability and no government regulation, that lady could have bought herself a new knee for about 10,000 dollars.
“my 92 year old mother was incarcerated in an elder-care facility by the State of New York. She went from being a free American citizen to being an inmate in a the blink-of-an-eye. ”
My mother knows that she will live with me if she becomes old. We will use whatever income she might bring with her to hire a sitter as needed. It is my expectation that she will die at home.
It does seem odd that those who cannot afford to fix their children’s teeth or to fix their own torn rotator cuffs are taxed so that retirees can return to the golf course.
We would feel it was wrong if a man who couldn’t afford a car,and rode his bike to work were forced by gang members/government to pay for the repairs on his neighbor’s car. The price of the surgery (in India where there is no malpractice/regulation) is the price of a new car.
Clueless said,
“It does seem odd that those who cannot afford to fix their children’s teeth or to fix their own torn rotator cuffs are taxed so that retirees can return to the golf course.”
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How do you equate an elder’s lifetime of ‘material contribution to’ and ‘service to’ those around him/her to the needs of those who have yet to make the same sort of contributions to those around them?
As soon as you take measures to ‘triage’ the amount of “love” that you have for your “neighbor,” you are trodding on shaking spiritual, moral and ethical soil.
“How do you equate an elder’s lifetime of ‘material contribution to’ and ‘service to’ those around him/her to the needs of those who have yet to make the same sort of contributions to those around them?”
Obviously that depends on the elder. Which is why I have no trouble supporting my mother. Some of my peers whose fathers divorced their mothers and abandoned them in order to engage in more enjoyable lifestyles feel differently.
I think it is entirely appropriate that families take care of their own. If Mom needs a new knee, and can’t afford it, my brother, sister and I will probably chip in and buy her one for Christmas. That is what families used to do back in the days when family was important. It used to be that a father would be ashamed to divorce his wife, abandon his children and go “find himself” in a new sexual relationship. It used to be that grandparents would stick around the home town babysitting their grandchildren, tutoring and counselling, rather than playing golf in retirement communities on the beach
I think families should take care of their own. I always have thought so. Society should take care of emergencies.
Part of the trouble is that many of today’s “elders” have NOT in fact provided a lifetime of significant ‘material contribution to’ and ‘service to’ those around him/her.
The generations who follow them have paid for their elders selfishness for decades, and are now being set up to pay even more.
“As soon as you take measures to ‘triage’ the amount of “love†that you have for your “neighbor,†you are trodding on shaking spiritual, moral and ethical soil. ”
Shouldn’t that love be extended to the young? Also shouldn’t that love be extended to those who work? Why should they work to provide for those who do not work what they cannot afford to provide for themselves or those they love?
Why are the old and the retired first in line? I would think it should be the children whose medical needs should receive first priority, not the elderly.
Clueless said,
“Why are the old and the retired first in line? I would think it should be the children whose medical needs should receive first priority, not the elderly.”
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Somewhere in Scripture I remember having read, “Honor thy father and thy mother.” Its also in the decalog in the prayer book. God didn’t include any qualifying clauses with this commandment.
It is not much of an interpretive extrapolation of this commandment to say, “Honor the elderly.”
It may be that God found it necessary to admonish those who would disregard the needs of the elderly.
“Honor thy father and thy mother.†Its also in the decalog in the prayer book. God didn’t include any qualifying clauses with this commandment. It is not much of an interpretive extrapolation of this commandment to say, “Honor the elderly.â€
I disagree. Charity begins at home. There is a vast difference in the children of Israel caring for their own parents (and children) and being enslaved to look after the elders of Egypt, Rome or Babylon. In no other country are the obligations of individual family members palmed off on Society at large as occurs in the United States. In Sri Lanka there is poverty, but no nursing homes. The parents of beggers sit in the doorway of the coconut thatch homes of their children, and they watch their grandchildren as they come home from school.
US society has taken Gods command to individual Christians and has turned it into an excuse to abandon both children and parents to the mercies of “Society” using religion as an excuse.
I think our generation is going to pay dearly for doing so. (And I think we Boomers deserve it).
Clueless,
The extended family in the United States is broken. Its broken because of our society’s mobility (we often live far distances from our parents, sibliings, aunts and uncles and cousins) and its broken because many of us wouldn’t look after members of our extended families even if they were to live next door.
In fact, many of our younger people ‘sponge’ off their parents well into adulthood. By doing this, they drain the resources that their parents might have used to prepare for their elder years. I am fairly sure that my older brother did this to our mother.
However, I do agree that we have become a society where, some how, we expect the “state” to provide for us and thus take little or no responsibility for being prepared for our own emergency or ‘in extremis’ needs.
I do not like the idea of supporting lazy and/or self-indulgent people who act as if the “state” has an obligation to pay for those ‘needs.’
In fact, I do not accept the concept of the “state” as some sort of entity that has an existance independent of the Declaration of Independence, the Constitution or the Bill of Rights. The “state” only exists because the citizens of the United States willed it to exist. It is an expression of their will based upon their individual rights as citizens of the United States. Officials, including politicians, of the “state” are employees of the citizens.
Having said that, as a Christian, I believe that I have an obligation to “love my neighbor” when that neighbor is in ‘legitmate’ need.
But, I do not have an obligation to perpetuate my neighbor’s self-perpetuating and parasitic social/economic behavior. I have no obligation to be an ‘enabler’ of self-centered and selfish people who do not have ‘what it takes’ to ‘boot strap’ themselves up into self-sufficiency. Particularly when that behavior is generationally perpetuated.
#11
The extended family is broken because Americans find it conveniant to have it broken. It is easier to let your girlfriend have the baby, send a tiny portion of your salary as child support, and have her go on aid to families with dependent children, than to be a husband and a father. Husbands and fathers not only have monetory duties, but they pay vastly more in time and labor.
However it is more convenient for “Society” to take care of the “poor” than for people as individuals to do so.
Similarly, it is not necessary for people to move 200 miles away, and simply send Mother’s day gifts. They can invite their parents along. They can stay home and give up the big raise, because after all they have duties as sons, daughters etc. After all, when a family moves to get a better job, they do not (usually) leave their children behind. Being in a family requires sacrifice.
The current generation of oldsters and their children simply feel that the sacrifice involved needs to be made by somebody else (currently the young) so that they can enjoy their “freedom” and “golden years” without feeling guilty.
In point of fact they should feel guilty. People who let society take responsibility for their mothers are no better than those who let society take responsibility for their children. If they are dead, horribly disabled or impoverished, okay. However that is rare, today.
Just get all the Boomers to give up medical care from our broken hopeless system that fails everyone (so how did the Boomers get this old?) and give that money to the appropriately selected target groups.
Alternatively, Americans could view dying as a natural part of life and plan for no heroic measures – like living wills, and refusal of resuscitation, and declining treatment. Yeah. Remember that opt in/opt out bit about behaviors?
My sister holds a durable power of attorney for health care, and I have a living will. If I have easily treatable disease (localized breast cancer) then I will seek treatment (since I can continue to contribute to my family). If I have widely metastatic cancer, I plan to refuse chemotherapy and radiation and insist on no interventions other than pain control. When I lose my appetite and the nausea makes drinking a problem (inevitable as the end nears), I plan to not eat or drink. This will result in the inevitable dehydration, aspiration pneumonia and the relatively peaceful death that used to be called “the old mans friend”. My goal is to die in my own bed, with a large DNR sign warning all do-gooders off.
Dying is indeed a natural part of life. Further it is a lot more fun than a lot of things that take place in the last 6 months of the lives we currently give our preterminal elderly, at vast cost in the hospital.
My wife and I have set up an estate, and one of the provisions of that estate is a living will. We have both directed that no attempt is to be made to artificially extend our lives beyond giving family and friends enough time to say their goodbyes. No expensive procedures, thank you……just let us go in peace, and at home.
“Well, in point of fact that is the way that Europe works. At 50, no dialysis, at 60 no back/knee operations. The way it was explained to me is that the taxpayer has a right to fund only those elective operations that will result in the patient also being a taxpayer and a contributing member of society. Those who are no longer paying taxes are not entitled to the same list of procedures to which taxpayers are entitled.”
Not to be disagreeable, but “Europe” is a continent. A continent composed of many countries with wide varieties between their health care systems. Saying “that’s how they do it in Europe” is easy… pointing to an actual country that has such policies is more difficult (for good reason- I highly doubt that is an fully accurate description of any western European nation’s policy).
The one area in which one can apparently use a generic “Europe” is cost: it seems that each and every western European country manages to get similar ( or in many cases, better) health outcomes for less money.
Having experienced the “Bismarck” model used in Germany and Austria, I can’t see why we shouldn’t or couldn’t implement such a system here. With all the “horror” stories floating around about the British and Canadian models, I have yet to see one from Germany.
(Or, for that matter, Switzerland, Luxembourg, Sweden, Belgium, Norway, Finland, Spain, Italy, Portugal, Austria, France, etc. etc.)
I am really surprised that so many of you seem to think a public health system would discriminate against the elderly. It wasn’t our experience here in New Zealand when my 81 year old mother needed a hip replacement — nor when a friend, well into her 80s recently needed extensive knee surgery. I have known nearly 100 year olds get major surgery – the criteria is “will it help” not “how old are you”.
On the other hand, I have known much younger people denied surgery, not because of their age, but because on balance it would do them no good. My father (aged 72) was told that if he had the heart surgery he needed he would die on the table … so society would not provide it because it did not want to kill him. Instead he had (probably at least as expensive) home help etc so he could live a good quality of life with it. Similarly our system says to terminal cancer patients “we can do no more that is worthwhile — now we move to palliative care.” I had the very great misfortune to be a support person to a solo mum who was told that this was the case for her 18 month old baby with a brain tumour — heartbreaking yes – distressing beyond words – but kinder than putting the child through yet another operation (he had already had so many) which was pointless. Instead again she was offered all the help and care she needed to make the child’s remaining days as good as possible.
Is that rationing? I would argue not — it is providing the highest level of care that the doctors can give. Much higher level of care than the approach of “everything your bank balance or insurance company will stand”.
I think that both Clueless and AnglicanFirst raise excellent points about the presenting issue. I’m a physician, and I have to shake my head at the amount of death-denying and clawing to “do everything possible” that ends up in a heap of ICU care for those at the end of life. Juxtapose that with the need for better prenatal care, to say nothing of the apparently casual slaughter of so many unborn through abortion. Not a very Christian picture, either.
That said, what Clueless and others say about caring for one’s parents strikes a very deep chord in me. When my stepmom died suddenly 6 years ago, we were faced with the choice of how to best help my Dad, who had depended on her and lived 900 miles away. Long story short, we moved him up to our town, and even though he insisted on having his own apartment in a nice retirement home, we helped him with his many medical issues, and more so did our best to honor him as father, father-in-law, and ultimately grandfather. Lots of Sunday dinners, stopping by to check in on him and get him as much time with his granddaughter as possible, trips to the ER and hospital as his condition declined, trying to be both son and medical advocate for him. It was, especially for the last six months of his life, often physically and emotionally exhausting for both my wife and me, and we deferred a goodly amount of “personal time,” vacations, etc. And we did quite willingly avail ourselves of a motorized wheelchair and other medical aids and interventions for him, to give him some continued mobility, symptom relief, and (I think) a sense of dignity.
But I wouldn’t trade it for anything. He died peacefully in his “new home,” having made many dear friends there, and enjoying the love of his new granddaughter for his final two years. And I feel so blessed to have been able to give back a fraction of what he gave me.