End-Of- Life Medicine

Having lived through several very personal ends of life I feel qualified to comment. I have seen different life ends with vastly different medical costs. What the country needs is a thorough vetting of this, and related issues. Unfortunately as this article points out Americans don’t want to talk about it. Even if we pass some watered down health care “reform” the end of life issue will not be adequately addressed because we don’t talk about it as a nation. I have seen Medicade prolong the life of a dying woman and another just sit in a chair and die, with virtually no additional expenses. My wife and I have done almost all we can do to make those hard decisions and prepare wills with powers of attorney and yet if catastrophe hits us we are not prepared to pull the plug.

Much of this debate is left off the table. It is a reflection of our cultural mores. 150 years ago people died in their homes, with their families gathered around, when it was time it was just time. Today many people are in assisted living (joke) facilities or nursing homes and the system picks up the expense instead of family. That part is not political it is cultural. As long as we continue to deemphasize familial and personal responsibility and accountability as a culture the end of life issues will rage on.

Here are a few of the pertinent paragraphs from this article.

“Almost a third of the money spent by Medicare—about $66.8 billion a year—goes to chronically ill patients in the last two years of life”

“Studies show that about 70 percent of people want to die at home—but that about half die in hospitals.”

 “Our medical system does everything it can to encourage hope. And American health care has been near miraculous—the envy of the world—in its capacity to develop new lifesaving and life-enhancing treatments. But death can be delayed only so long, and sometimes the wait is grim and degrading. The hospice ideal recognized that for many people, quiet and dignity—and loving care and good painkillers—are really what’s called for.”

http://www.newsweek.com/id/215291/page/1

Madmen

http://www.amctv.com/originals/madmen/

For anyone who has not yet seen Madmen on AMC you have a treat instore for you when you catch it. It is very sophisticated black comedy about life in a Madison Ave Ad Agency in the 60’s. It is faithful to costume and period sets and the American culture of the day. The scripts are riviting and the characters are well developed. It isn’t often that multiple characters can all hold our attention like these can.

It refelcts what was happening in America as different clients come through the doors. This years (1963) hot stories so far have been diet cola, bicardi, Israeli Tourism, Pan Am, etc.

It is the first cable show to win an Emmy for best drama. 

It’s great with DVR just breeze right through the commercials.

 

 

The Healing Of America by T R Reid

I listened to T R Reid talk about this book on NPR as I drove back from the panhandle last Monday. He seemed a pretty interesting person and had a folksy engaging style that focused on healthcare systems around the world. In essence what he said was the main element that prevents the US from having affordable healthcare is profit. Almost the entire non-government run system is profit driven. When you think about it, our healthcare reflects our national culture’s history…..The business of America is now, and always has been, business. No other industrialized nation has the profit issue in their system and no one else has the mal practice premiums our doctors have to carry. In most other countries doctors education is free, hospitals don’t make profits and neither do private insurance companies. But there is a more basic issue that screams to be addressed which I will come to presently.

 

I read the book, it was not as engaging as his interview, I was looking to find answers and proposals, and instead what I found was comparative analysis, which gets more than a little boring. It is sometimes interesting what some countries have in place. France for example, has a medical ID Card that carries all individual medical records on it. A patient walks in and hands the card to a doctor who puts it in a scanner and the entire medical history is available…….the carte vitale vastly reduces administrative overhead and costs.

 

Overall the book is too rambling and not graphic enough to use as good concise data. Reid does hit on what I think is the fundamental disconnect with our national debate which is to say that the debate is putting the cart before the horse. In all other democratic industrialized nations, before enacting whichever form of universal coverage they have now, they had a national debate on the ethics of healthcare. He concludes in chapter 12 The First Question…..”What are our basic ethical values? Do we believe that every American has a right to health care when he needs it? After that question is resolved we can move on to designing a health care system that works for all Americans. When we get to that stage we can draw on a world of ideas and experience—–all the lessons we’ve learned from health care systems in other industrialized democracies.”

 

I agree. To effect universal change there must be consensus from the people, clearly we don’t have that today.

 

Here is another review for consideration.

 

 

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/23/RVBE19431R.DTL&type=health