Sunday, November 27, 2011

Living Wills and the Will to Live

When the public funds your lifestyle, it has a right to question your lifestyle choices.  That includes health care.
"It is a good day to die"
-- Old Lodge Skins in Little Big Man
"We've got a duty to die and get out of the way with all of our machines and artificial hearts and everything else like that and let the other society, our kids, build a reasonable life."
-- Colorado Governor Richard Lamm
A good discussion broke out in the comment thread of a recent blog post, Rule of Law. We got off on a healthcare tangent, but it was an interesting exploration of life and death.

Finntann kicked it off with a raw, ripped-off scab look at reality that had a sad ending ...
The failure of modern medicine is not in treatement or cost but directly attributable to our innate desire for immortality.
It's harsh, but we treat those that we should not treat. We refuse to accept the diagnosis of mortality. We trade vast fortunes for six months, a year, two years to the detriment of all involved, except those making money off of it.
What is reasonable action and what is reasonable cost? How much is six months of additional life worth?
My sister died of breast cancer a little over a year ago with medical bills well into the six figures. In the end, she wished she had gone to Europe instead of to the doctor.
AOW then chimed in with a report from real life about insurance and existing conditions. As her blogger buddies know, she's been navigating the health care system as she nurses her husband back to good health. She knows what she is talking about.

Ducky had good advice on medical directives...
My family knows exactly what to do. If quality of life has been lost, end it.
This spurred KP (after telling a great story about a Vietnam war combat pilot) to remind us that it's not always so simple:
A perfect example would be stroke in the midbrain. Patient is unconcious, surgeon tells you the stroke is "in a good place" making decent recovery possible. You have five minutes to decide what to do at 4:30am. The directive isn't worth the paper it is written on. You will decide while trying to gather some degree of medical certainty.
Quite simply, all of this is properly the purview of the individual and the family, upon consultation with the family's doctor and pastor.

Collectivizing health care by pushing our money into a big government pot makes our private affairs public

In a government-run, publicly funded healthcare system, every medical and lifestyle decision becomes the purview of every taxpayer and of the armies of bureaucrats who are charged with the custody of government funds.

Justice Kagan will shake her gavel at you and tell you to each your congressionally-mandated vegetables, and put out that cigarette!  If government-enforced diets and exercise save me from paying for the diabetes, obesity and other expensive health problems of the fatties among us, why not?

Life and Death

Who's life is worth more, the 87 year old physics PhD who is still doing productive research, or the poor child living in a ghetto?

Government-created scarcity will inevitably bring about such utilitarian decisions.  Wouldn't it be better to get government out of it, completely?  Free up the insurance industry to craft policies tailored to specific groups and let a well-policed free market set prices and determine what care looks like.  More importantly, let the consumer see what the real price of health care is.

Cut out the red tape and overregulation, and set the consumer free in the marketplace with his or her own dollars, and prices will come down.  They always do.  The truly indigent could be helped by government paying their health care premiums instead of setting up a whole bureaucracy.

The alternative is a scolding nanny state making all your decisions for you, creating a nation of infants.  Some would say we're already a long way down that road.


dmarks said...

Might as well call collectivizing healthcare Stalinizing it instead. It's a system where the ruling elites make all the decisions, and the people make none.

The outrageous thing about the push for the ruling elites to control healthcare is that it all ends up being welfare for the well off and wealthy. And that is entirely unnecessary.

As you imply, the truly indigent, disabled, vets should be provided a government safety net.

Those with the means to pay for it don't need a hammock from the government.

One example of a program that should be significantly changed a lot is SCHIP. It was intended for indigent children, but the Democrats pushed to make sure it got expanded to rich adults. That's billions going to adults of means as part of what was supposed to be a welfare program.

What has been surprising lately has been the strong push by Dems for welfare for the well-off, in general. The governor in Michigan is trying to cut off millionaires and students attending elite espensive universities from receiving food stamps. And predictably, the Dems are blocking reforms.

Always On Watch said...

When the decision was made to put Mr. AOW into a nursing home after his midbrain hemorrhage, Blue Cross told me, "He probably will be going in to stay. Apply to Medicaid."

After five weeks in the nursing home AND with our family doctor's consent, I brought Mr. AOW home, but I had to threaten litigation to get my husband out of the clutches of the nursing home. I told the entire sorry tale in the link I just left.

Had I not been smart enough to take the nursing home's doctor off my husband's case AND to include Mr. AOW's attorney on the intake papers, I would have had a helluva time getting my husband home. Furthermore, if one does bring home a spouse AMA (Against Medical Advice), the health insurance policy is void. VOID!

My next comment will be more to the point of Silverfiddle's post.

Always On Watch said...

My husband has had a medical directive since his brain surgery of 1993. As a result of that life-threatening surgery all those years ago, Mr. AOW and I have talked many times about end-of-life matters. Such a conversation is one that all of us should have -- and not just as we're approaching our senior years, either. As my father used to say, "Anything can happen to any of us at any time."

The afternoon of Mr. AOW's brain hemorrhage, the doctor said to me, "He may not make it. Does your husband have a living will?" I replied in the affirmative. The doctor said, "Go home, and get those papers."

I keep referring to "the doctor." However, once a patient is in the clutches of the hospital, the doctor in attendance is not one's own. This is an important factor -- and one that is often overlooked in discussions on health care.

It DOES matter who the doctor is because specialists don't see the whole patient. A brain surgeon wants to operate, a physiatrist wants to set up a regimen of physical therapy, etc.

Back to my personal story....I refused to let the intensive care folks put my husband on a ventilator. The most difficult decision I've ever made in my life! But I know enough about neurology and the after-effects of artificial ventilation to know how dangerous using that measure is, particularly with regard to what most of us consider "recovery." In my view, a vegetative state and/or dependence on a ventilator is not living or recovery.

Always On Watch said...

Who's life is worth more, the 87 year old physics PhD who is still doing productive research, or the poor child living in a ghetto?

Government-created scarcity will inevitably bring about such utilitarian decisions.

We mustn't kid ourselves. Private health insurance companies are already making such decisions.

For example, if one doesn't meet certain benchmarks, one's PT and OT are terminated. In fact, Mr. AOW was booted out of one hospital because he didn't reach the designation benchmarks in a timely manner -- never mind that Mr. AOW's private policy would have covered several more weeks in an intensive-therapy facility. His post-stoke PT and OT were again terminated one year after his stroke -- never mind that he was making progress. A year has now gone by since Mr. AOW's therapy was terminated. But get this! On Thanksgiving Day morning, he took three steps unassisted -- no cane, no leg brace, no caregiver. I'm sure that he'd have achieved that feat much sooner had therapy been continued instead of terminated.

The entire health care system is designed to force a seriously debilitated patient onto Medicaid and to leave behind an impoverished widow or widower. With 80% of all in nursing homes now on Medicaid (whether they gamed the system or now), Medicaid is quickly becoming unsustainable. What then? Roll Grandma out into the street?

Again, I highly recommend reading Jane Gross's book A Bittersweet Season, available at many public libraries. I wish that her book had been published before I had to navigate the system the hard way. I made some very expensive mistakes!

Always On Watch said...

Quite simply, all of this is properly the purview of the individual and the family, upon consultation with the family's doctor and pastor.

Yes, indeed!

But as I mentioned above, all the specialists taking charge makes that method of decision very difficult. Not to mention that the health care system is in search of "a pool of money we can get." Those very words were spoken to me at the nursing home when I was attempting to arrange Mr. AOW's discharge.


Fact: CPR on the elderly is not usually a successful procedure in the terms that most of us would use to define the word "successful." Broken ribs, broken ribs, oxygen deprivation, brain damage, dementia -- those are the results in over 90% of such resuscitations performed upon the elderly (I can't recall the exact age designation for "elderly."

About CPR:

When is CPR likely to be helpful? CPR was originally developed for persons who are otherwise healthy who suffer a sudden arrhythmia or develop a clot blocking an artery in the heart. In this situation, restarting the heart enables the person to reach the hospital for definitive treatment. The outcome of a return to normal function is attainable.

When is CPR not likely to be helpful? If the person is very ill with end stage cancer or end stage chronic illness, CPR is unlikely to help. The likelihood of a successful resuscitation is very low; the likelihood that those resuscitated will survive to be discharged from the hospital is minimal; the likelihood that the few discharged from the hospital will return to previous functioning is nil.

What are the burdens and side effects of CPR? It is not unusual, particularly for a frail elderly person, for rib fractures to occur. Vomiting with aspiration of the vomit into the lung and subsequent pneumonia are a possibility. Brain injury due to prolonged absence of oxygen to the brain is also fairly common. The person frequently requires placement on a ventilator to be able to breathe subsequent to the resuscitation.

Always On Watch said...

Those with the means to pay for it don't need a hammock from the government.

In general, I agree.

However, the economic plight of the healthy spouse also needs to be considered. Otherwise, you end up with two people on Medicaid and/or welfare.

With my husband's stroke and subsequent treatment, I discovered that everything was on the table upon exhausting the limits of health-insurance coverage. And I do mean everything, right down to the wedding ring on my finger.

The cost of nursing homes now approaches $20,000/month. Medicare doesn't pay for residential care. Medicaid does, however. But at a much reduced dollar amount of about $1000/month. Nursing homes are "gouging" paying patients because some 80% of the patients are on Medicaid. It's a scary scenario, I tell you. Medicaid is not sustainable as the Boomers move into old age.

And we're living longer. Back when Medicare was first enacted, the average age at death was around 60. Extended life almost always means the long, slow decline -- and that decline is unbelievably expensive.

Lest one believe that one can avoid the nursing home, know this: a hospital can refuse to release you to anywhere except the nursing home. Adult protective services (The Nanny State!) can legally force you into a nursing home -- and the health insurance companies, including Medicare, are complicit. Once you're in the home over a certain number of days, Medicare and private health-insurance are off the hook and the road to the spend down for Medicaid continues apace.

Silverfiddle said...

AOW: Sounds like a nightmare. I know you shrug it off when I mention it, but you really are a hero the way you've fought for your husband and his recovery.

When my granny could no longer care for herself in her home, she went into assisted living, which as you say is extremely expensive, just as a nursing home is.

The counselors told my dad that the choices were to pay some exorbitant amount monthly, or declare her indigent so that the government (medicare, medicaid? I don't know the detail) would pay.

She sold her home and declared herself indigent. For a widow or widower, not necessarily a bad choice, but as you brought up, that is not an option when the person has a living spouse.

For all my griping about the government, I thank God we take care of our elderly and poor in this country.

What upsets me is that the federal government, through these giant bureaucracies, has distorted the health care markets and turned them into a grotesque version of the company store.

You have no where else to go.

Anonymous said...

I was fortunate to live in "The best of times" for our country, and for Healthcare in particular. This is a scary time for those who are getting up there in age, or with health care issues. I know, I work in Healthcare. Be afraid, very afraid. They are telling us very little of what is happening and what is in store. For sure, Government owned,controlled Hospitals and Doctors.

Always On Watch said...

The impoverished spouse (living or widowed) is a serious, serious issue. I'm alarmed in the extreme that more people don't understand what can happen in that regard!

I'm not a hero, but I will admit to being "a determined German." My confrontations with the nursing home were ugly. Very ugly. I got nasty, but being congenial was getting us nowhere -- except for dooming Mr. AOW to years of living with people with whom he had nothing in common and dooming me to impoverishment at the age of 57.

Mr. AOW was only 59 years old when his catastrophic event occurred. Most are older. But not all! Shortly before Mr. AOW left the nursing home, a girl in her 20s arrived. Bad, bad case -- a car accident.

Furthermore, that particular nursing home had a pediatric wing. What I saw in there was the stuff of nightmares -- mostly birth defects. I'm sure that those children's parents were impoverished and that those children were on Medicaid.

Anonymous said...

I'll repeat and extend what I said the other day:

We have been hoodwinked by our own indolence, greed, and lack of courage to allow Government to cast itself effectively in the role of MAFIA.

It runs what-amounts-to an old-fashioned PROTECTION RACKET.

You know the routine: 

"We have the power to smash up your place of business, take your home away from you, steal all your money, rape your wife, cripple your kids, and kill you. In order to prevent that, all you need to do is give US 50% of every dollar you take in from now on ad infinitum."

Impossible to resist when a cadre of grim, hard-eyed thugs armed with machine guns marches into your life and shoots all the bottles off one of the shelves in your little pharmacy just to give you a sample of what happens to people who refuse to pay for "protection."

"And none can call [their] power to account. ..."

It's a near perfect parallel.

The threat of incarceration and confiscation of our property is ever present when dealing with those who serve our non-representational bureaucracy.

When government takes over, everyone’s hands are tied at the local level.

Doctors, nurses, family, domestic partners, and dear, personal, lifelong friends are not permitted to make common sense choices sensitive to the needs and wants of the individual whose quality of life is at stake. Such matters are controlled from “On High” by people who neither know the patient or care anything about him.

I will never forget what a social worker, arbitrarily assigned to my father’s case when he lay dying after living 25 years of progressive invalidism, told me when our hometown hospital was told by Medicare to discharge my 65-pound, blind, incontinent father with tubes sticking out of his head and several other places in his poor wrecked body, because “there wasn’t anything more they could do for him.”

I reminded her that both my parents had served as volunteers at the hospital for more than 30 years, and that my dad had made the scale model of the new wing then on display in the lobby with his own two hands, and shouldn’t we expect better treatment than that from an institution we had served so faithfully?

Here’s what she said, so help me God:

“Mr. FreeThinke, you’ve got to face reality -- nobody gives a good God damn about shit like that anymore.”

We had run out of money, and in those days Medicare would not pay for anything beyond a certain number of "permitted" lifetime hospital days.

Fortunately, father died three days after we were forced to take him home in that pitiful condition. Had he gone to a nursing home, the government would have taken possession of my parents’ house, and -- as AOW said -- my mother’s diamond engagement ring, and anything else of value they could lay their filthy hands on -- and she would have been left destitute.

I don’t believe an atrocity like that could have happened to my family before JFK and Lyndon Johnson forced government control of our most intimate personal affairs into our lives.

Apparently from AOW’s testimony things have gotten even worse. Now they can force you to put a spouse or loved one into a nursing home, whether you think it’s desirable or not.

This may shock and offend many here, but I am much in favor of having the right to purchase a SUICIDE KIT to be used at the discretion of a terminally ill patient -- OR those who must attend him if he lapses into what-is-cheerfully-known-as “a persistent vegetative state.”

LIFE is for the LIVING not the LIVING DEAD, and the government should have nothing whatsoever to say about how those terms are defined. It should be left up to the patient, his doctor -- and those closest to and most affected by the situation.

~ FreeThinke

Always On Watch said...

When my granny could no longer care for herself in her home, she went into assisted living, which as you say is extremely expensive, just as a nursing home is.

Medicare doesn't pay for residential care and is only now beginning to provide some limited home health care. For example, I've been told that once Mr. AOW is on Medicare, I can get someone to come in at Medicare's expense to give him a shower three times a week. As things are here right now, it's all I can do to manage that shower once a week. I know that sounds awful, but "it is what is is." My back, permanently injured by an illegal immigrant cab driver in 2005, can take only so much.

Back to the topic at hand....

If one enters a nursing home as a paying customer, even if only for a few months, one cannot be turned out of that nursing home. Something important to keep in mind: never enter a residential facility on Medicaid from the git go if you can help it. Medicaid assistance often means substandard care.

A lot of people spend all their money on assisted living, only to end up in full-care homes and on Medicaid.

Are we living too long? Maybe. We certainly are seeing more and more of the long, slow decline.

BTW, I recall when there was no such thing as hospice. The arrival of hospice care was revolutionary. We're going to need something similarly revolutionary within a decade because of the aging Baby Boomers.

Finntann said...

Frankly it is a nightmare.

My sister, after suffering a chemotherapy induced stroke spent about three months in the hospital before being transferred to a 729 bed continuing care facility for about a year.

With about 50 beds on the floor at $400 a pop, their is no way anyone can convince me the two nurses manning the station were making $1250 an hour.

True, she got physical therapy three times a week, billed separately, as was every other conceivable form of medical care.

My opinion is she'd have gotten better and more attentive care in a $400 a night hotel, which is basically what we were paying for, for accomodations somewhere far below a Motel 6. Frankly, she'd have probably gotten better care in a prison hospital.

I would call her in the evenings when I returned home from work, and had to go through the nurses station. Of the two nurses on second shift, one didn't speak enough English to communicate over the phone and the other one was always 'oh so inconvenienced' when we called. One could never talk to a doctor after 5pm, and we were always instructed to call back during the day.

Before I joined the military I went to UPenn for Medical Laboratory Science. It was a 3+1 program, the last year spent working in one of their affiliated hospitals. I lasted about six months... you don't even want to imagine what goes on behind the scenes in a hospital. It cured me of any and all desire to work in the medical profession.

Quit, got one of those jobs no american wants to do (landscaping), until my delayed enlistment time was was up and have been working in communications-electronics ever since. A much more rewarding and satisfying career than medicine ever was... come to think of it, so was landscaping.

My ex-wife was a nurse who did home hospice care in Massachustts until we moved to New Mexico and she discovered home hospice nurses were making slightly more than minumum wage. Not that we needed the money, but the level of care was what you would expect for slightly more than minimum wage. Neither of us works in medicine today nor will neither of us ever again.


KP said...

I hope this is not too far off topic: two parts.

AOW, thanks for sharing your experiences. My last two years have taught me a lot; and that’s coming from someone who has spent 30 years navigating the medical system from the provider perspective, and years navigating my daughter’s cancer.

Ten years ago my mother made it absolutely clear, I was to use the DNR (do not resuscitate) that was in place if I determined she was going to live without “quality of life”. I was happy to assist but wasn’t fully prepared for the difficulties attached to such a decision.

My phone call came two years ago at 4:30am and was told my mom had suffered a mid brain stroke. I had five minutes to decide her fate. I asked 3-4 pertinent questions about location of the bleed, how it might affect cranial nerves, speech, heart, lungs, memory and cognitive skills. She was in very good health before the vascular accident and living independently in a retirement community. With her voice in my head reminding me of the DNR I chose for her to have the brain surgery and deal with recovery.

It was the hardest decision I have ever made. Tied right up there with the decision not to operate on my fourteen year old daughters stage four cancer but instead focus on 11 months of chemo and radiation.

If you haven’t made these types of decisions I can assure you, they are rarely black and white and the learning curve begins at ground zero, no matter your past experience. My daughter is alive and cancer free. She is nine years off treatment as of last Tuesday.

Once the decision to resuscitate is made your decision making is not over. In my mom’s case the brain surgeon place shunts on both sides of the skull to drain cerebral spinal fluid to prevent hydrocephalous. One week later the shunts failed, she suffered hydrocephalous (swelling of the brain) and the ventricles did swell into her brain. Again, I had to make the decision whether to exercise the DNR or have another surgery. I went with the surgery. Two weeks later the shunts failed again. So a stroke and two rounds of hydrocephalous made the decision making more convoluted.

The fight was just beginning. I know this is a long story but perhaps I can help AOW or others who will have a similar experience. As AOW said, to get Medicare to agree to pay for a Rehabilitation facility as opposed to skilled full time nursing is a war in itself. If the patient does not have an advocate at this point they are lost. Your case manager at any hospital makes the call.

KP said...

What they do not want to see and what Medicare will not pay for is a patient who goes to rehab but returns to skilled nursing care. To qualify for rehab there has to be a reasonable medical certainty that the patient will return to assisted living or independent living. The hammer Medicare holds over the hospital's head is the threat of not paying the patients bills if rehab fails. So the nurse case manager is governed by this.

This is where the real work begins for an advocate. I got my mom into rehab once I convinced the nurse case manager that my mom would improve; or that I wasn't going to get out of her face.

Once in rehab I started I advocated for continued PT, OT and speech therapy. After 22 days she was moved back to her three tiered retirement facility (independent, assisted living and skilled nursing – lowest level) and placed in a skilled nursing situation.

She was still low in level of functioning but I was seeking a neurological examination and evaluation that could shed new light on her diagnosis/case. Each new hydrocephalous event was a new injury and the numbers of days of rehab are tied to new injury dates. Her therapy was stopped before I could get an additional advocate in the neurologist.

Once the neuro exam was completed Dr. Rosenfeld diagnosed her with progressive supranuclear palsy as a result of the brain bleed in the brain stem areas combined with the three bouts of hydrocephalous. Now we had a new diagnosis; no longer just “stroke”. Supranuclear palsy is a movement disorder caused by damage to certain nerve cells in the brain. Her neuro prescribed sinemet for her symptoms (balance, eye movements, trouble swallowing, memory, falling, etc ). Sinemet has proved to be an enormous help. My mom spent Thanksgiving with us and is nearly independent after two years. This is the type of progress that can be made and what Mr and Mrs AOW are seeking. Do not give up or become complacent.

If you find yourself in the position that AOW and I have been in be ready to advocate in a full time way. The system demands it. Administrators are over worked and burdened by cost. They need our help as do the patients. KEY: the initial fight for rehab and the struggle to get a complete diagnosis. My mom’s life is worth living and the sinemet was close to a miracle for her. I am happy to share my experience, strength and hope with anyone who wants to contact me directly at kevprcll at aol.

Anonymous said...

WHEW! Time for a Levity Break:


Razors pain you;
Rivers are damp;
Acids stain you;
Drugs cause cramp.
Guns aren’t lawful;
Nooses give;
Gas smells awful;
You might as well live.

~ Dorothy Parker

Of course Parker -- whose own rather sad life ended tragically -- didn't have to contend with Government-Supervised Medical Care. She was a brilliant woman with a soft and tender heart, despite having earned a reputation for cynical wisecracking of the most trenchant, pitiless variety. She feel for Marxism, because of her great empathy for human suffering. I wonder what she would have thought if she'd ever had to deal with the grim realities of Heartless, Conscienceless Totalitarianism at work in her own life?

~ FreeThinke

Always On Watch said...

You make such excellent points, among them the following one:

To qualify for rehab there has to be a reasonable medical certainty that the patient will return to assisted living or independent living. The hammer Medicare holds over the hospital's head is the threat of not paying the patients bills if rehab fails.

It is not only Medicare holding that hammer. So do private health insurance companies, such as Blue Cross, the one that Mr. AOW and I have our policies with.

And the matter of a new diagnosis is critical with regard to obtaining rehab.

Always On Watch said...

Something important about a DNR:

My father, in the final stages of lung disease, had a DNR posted in his home (He lived alone, all the way until the end at age 86.5).

But a DNR posted at home or registered with a hospital has one serious limitation: once a patient is in an ambulance, the DNR is null and void in that venue. The goal is to transport the patient alive to the nearest hospital, and all measures, including extreme measures, are legally required.

Once at the hospital and once the ventilator is in place, one can have a serious battle on one's hands as medical proxy. Such a thing happened to my uncle, and he lived in a vegetative state until pneumonia set in.

My family doctor warned me about calling 911 from my father's home. Sound cold? Not really. My doctor had to make the end-of-life decision for his father, who had also been our family doctor, BTW.

Making end-of-life decisions for someone else is an inexact science -- and one is under incredible moral and emotional pressure, with only a very few minutes to make the decision. And remember that a doctor's advice is just that -- ADVICE.

Mankind today has great difficulty even believing that there is such a thing as mortality. Well, there IS! When it gets to the point that the patient says, "If a dog were suffering as I'm suffering, they'd put that dog down," then the denial of mortality has gone too far. Many elderly patients attempt suicide by doctor (undergoing surgery that is likely fatal), and some elderly patients with the stipulation of no feeding tube starve themselves to death. These events happen more often than we like to think about.

KP said...

You are correct -- my mom's supplemental was Anthem Blue Cross and they wielded that hammer. It is an adversarial relationship between hospital and insurance company. At point my nurse case manager in Santa Barbara, CA. would not communicate with an Anthem Blue Cross manager in Atlanta as they were waring. I used my personal cell phone to call and find the gal in Atlanta and handed it over to the case manager in SB. That is how I finally got my mom rehab!!

As well, I couldn't get Medicare to alter the date of injury so my mom's therapy was stopped prematurally. I appealed the decision to the highlest levels of Maximus Federal Servces and brought her case to a US Administrative Law Judge asking him to review rule 42 CFR 422.101. We were rejected. Thank goodness she saw the neuro. She has been improving since then.

Lastly, my two brothers and sister wanted to hire a 24hr a day nurse for my mom. I insisted that we challenged her with more independance and responsibility. Like my kids, I chose when to have them (make them) try and fail and succeed. It is the faster way to learn. My best to you guys.

dmarks said...

Realize that the bad situation with Anthem in many places is a result of government intervention in the free market to prevent competition. Anthem and Blue Cross often has special sweetheart deals which make them the near-monopoly in a state, or at least having an unfair advantage over competitors due to regulations designed to keep out competition and special government favors given to Anthem/etc.

Anonymous said...

The heart asks pleasure first --
And then excuse from pain --
And then those little anodynes
That deaden suffering --

And then to go to sleep --
And then, if it should be
The Will of its Inquisitor --
The liberty -- to die.

~ Emily Dickinson (1830-1886)

Submitted by FreeThinke

Ducky's here said...

Nobody seems interested in what roe profit plays in distorting the health care delivery system.

Was a time when many insurance companies in America were non profit. I believe all insurance companies in Germany and other European nations are required to be non profit.

What value to consumers are insurance company profits?

Should we allow the fantasy that drug companies need the profit for research when they spend far more on advertising and stock options than they do on research?

I don't think this "free market"(LMFAO) is the savior you imagine.

Z said...

Finntann, I'm so sorry for your loss.
KP, what a story...I'm glad to hear of your daughter and your mother's recoveries!

I know Mr. Z would have wanted a DNR had his amyloidosis not killed him 2 years sooner than was thought...I think that I have that in my Will, too, but hearing KP's mother's story gives me pause!

DUCKY: re German health insurance...92% get health care paid for by the gov't (though the government, since Schroeder's last 2 years has been begging people to go on private insurance because they literally can't afford paying anymore). People not on GKV (German assistance) buy private for-profit insurance (My stepdaughter pays $1000 a month for her health insurance at 40 years old...approx $300 more than mine and I'm practically old enough to be her mother)
Only 0.3% of the population hasn't any health insurance, and that's the rich who don't need it and the very poor who get it through social assistance.
And, that health care "through the government" also is not completely free, believe me.

In Germany, the prices for MRI's, surgeries, etc., (and in France, by the way), are SO MUCH CHEAPER than here it's astonishing. Our prices might go down if competition stronger.

Did some of you realize that Obamacare will only cover you up to $5000 a year? I hope I'm wrong, but I've been getting information on that lately and THAT's scary..particularly when The Blues will have to shut down for lack of business a few years after it takes over. Horrifying. And at least even some liberals must be starting to understand how problematic it is because the polls are so low for it.

Silverfiddle said...

Ducky, I will assume you know what non-profit means, so I won't digress to point out that even non-profits need to keep the balance sheet in the black.

So are you blaming the need to please demanding shareholders with bigger and bigger gains (or dividends, as the case may be)?

dmarks said...

Ducky said: "Should we allow the fantasy that drug companies need the profit for research when they spend far more on advertising and stock options than they do on research?"

It's not a fantasy, actually. Look at all the useful drugs these commercial companies have come up with, including AIDS treatments. These for profit drug companies are at the forefront of research and development.

There are no quotes needed around free market. So why do you use them?

Jersey McJones said...

The "free market" (which is just a fantasy) has no place in our healthcare, and most of the civilized world knows it. We're just to unimaginative to understand why.

There's a simple axiom that explains why we do not have universal healthcare in America today: at any given moment, most people are healthy, and lack the imagination that at the next moment they may not be.

The answer to this problem is one single universal pool of health insurance. If the wealthy wish to pay for something else, they will. For the vast majority of us, we are one catastrophic ailment away from poverty or worse. The most efficient, realistic system would be universal. The system we have now is failing.

There is not the profit incentives for a useful health insurance industry. There are not enough rich people willing to pay the costs to make it useful to the majority. Take for instance Paul Ryan's silly plan to individually block-grant Medicare for the elderly. Just how retarded would one have to be to found an insurance company for the elderly with government assistance only amounting to perhaps half the average costs?

It's stupid.

you guys are looking at this like reptiles. Be human for a change, will ya'? Being cold doesn't make you calculating.


Anonymous said...

D. Marks said, "Might as well call collectivizing healthcare Stalinizing it instead. It's a system where the ruling elites make all the decisions, and the people make none."

It is difficult for me to sympathize with “the people.” After all, they elected the statists; they keep electing them. Lacking critical thinking skills, “the people” are putty in the hands of people who lie for a living. It has been this way since the beginning of the progressive movement; since progressive educationalists have taken over our public schools. “The people” are getting dumber by the day.


KP said...

<< hearing KP's mother's story gives me pause! >>

If we empower ourselves our health and the health of your family is supported.

The more maths and budgets we use to decide who gets what care the more people will fall through the cracks.

Ducky’s observations are also reality. As in most case -- there is no perfect ideological point of view.

End of life care is an incredibly expensive journey destined to end in death. The last 2 to 3 years of life generally cost more than the entire life before it. It is why we are all so interested in DNR.

Personally, my goal is to maintain control with early decision making. My view, do not wait for the system to make your decisions for you.

I belive this is a common ground between far left and far right.

Jersey is at the top of the food chain of the smartest cats I read on blogs.

<< you guys are looking at this like reptiles. Be human for a change, will ya'? Being cold doesn't make you calculating >>

Doode, there is no angle I haven't examined. Unless I don't know what I don't know. I ask you to help me have a deeper understanding. Feel fre to let me know what you know that I don't know.

KP said...

To be clear, I don't want my wife and kids to suffer for me. Nor my country. I would give up a few years of life to avoid that. My family might not agree. Oh well, half of us don’t either.

At the same time; if you are making decisions for someone else; I have an empathetic perspective and experience.

Ducky's here said...

@Silverfiddle - Ducky, I will assume you know what non-profit means, so I won't digress to point out that even non-profits need to keep the balance sheet in the black.

Don't patronize. You know exactly what I mean.

dmarks said...

JMJ: "Just how retarded..."

JMJ, I've heard you bash gays as "faggots".

Why now are you bashing the mentally disabled? It guess it is par for the course.

Time to get educated and stop the bigotry in your comments.

You have a track record of using the worst terms against gays and lesbians, and now against the disabled. What next, will you refer to blacks using the N-word?

It's interesting how the worst hatred for those who are "different" often comes from the Left.

After all, it was President Obama who bashed Special Olympics athletes on the Letterman show. you just won't find examples of Bush having done this. Obams's White House chief of staff has bashed the mentally disabled as 'fu**ing retards".

Can't you guys make your points without using the most vicious hatred?

KP said...

JMJ is not a bigot. There's no malice here. Perhaps not perfectly PC but most of us want to be able to use the English language as well as he does. Damn, if he would only agree with me :-)

Anonymous said...

If all of us were fortunate enough to have a spouse as devoted, determined and brave as AOW, or a strong, knowledgeable and loving son like KP, we would not have to worry so much about these heart-wrenching issues, but unfortunately many of us don't.

I, myself, live alone. I will be 71 in the spring. Much of my life has been dominated by the chronic invalidism and profound disability of loved ones, and the long slow decline into dementia that too often comes with great old age. I've experienced these things for decades up close and personal. There are no easy answers. It isn't even easy to know what questions to ask.

I don't believe there will be anyone I could trust o feel confidence in to run interference for me as the end approaches, or keep me free from mistreatment by the system.


The best advice I could give would be to accept your mortality, realize that one day you will die. No one -- no matter how rich, how fit, how strong, how tough, how brilliant, can escape the process forever.

Meanwhile, don't worry. Live life as fully and as joyfully as possible. Keep your focus away from yourself. Get interested in other people, and do whatever you can to make their lives a little brighter and a little more comfortable. Your own will become much cheerier, more stimulating and more rewarding in the process.

Life and death decisions ought not to be made for us by impersonal authorities devoted primarily to cutting costs and maintaining organizational efficiency.

I most fervently believe that terminally ill patients ought to be given free access to as much pain medication as they might want. I also believe the means of committing suicide -- speedily and painlessly should be provided for anyone who requests it -- and that husband, wives, children, lovers, close personal friends and family doctors ought to be able to help hopeless cases to commit suicide without fear of interference or prosecution by the authorities.

On the other hand no one no matter how he or she might be suffering should be coerced into committing suicide merely for convenience of an institution whose resources are overstrained, or by a spouse of family member who simply has gotten tired of shouldering the burden.

Very often success in these delicate may be determined more by personality, charm and character of the individuals involved. Clinical knowledge of the illness, while possibly useful is nowhere near as helpful as doughty, cheery, nanny-like figure who makes a good pot of tea with ginger crisps, jam and lemon curd tarts, thin watercress sandwiches with fresh butter, and fish paste pinwheels cut in thin, even rounds sprinkled with fresh chervil --or cream puffs stuffed with deviled ham and egg salad.

Dress well when you visit your charges. A touch of glamour can be very heartening, Pretend that both of you are about to embark on an adventurous outing.

Read short stories aloud. Get the patient involved in the reading if possible.Play card games. Play checkers, play board games. Start raising widow plants. Possibly learn to tend a bonsai tree or two. Grow citrus and avocado trees indoors. etc., etc., etc.

Write haiku, write limericks, write double dactyles,

Keep involved with endless projects. If doesn't matter if they're any good or not. The value is in the attempt not the finished object

The joy is in the journey -- rarely the journey's end.

~ FreeThinke

KP said...

Freakin' Free Thinke ... that was beautiful.

From the chorus of a song I grew up with in SoCal "Cielito Lindo":

Ay, ay, ay, ay,
Canta y no llores,
Porque cantando se alegran,
Cielito lindo, los corazones.


Ay, ay, ay, ay,
Sing and don't cry,
Because singing makes us happy,
Like the beautiful sky, our hearts.

Always On Watch said...

I don't believe there will be anyone I could trust o feel confidence in to run interference for me as the end approaches, or keep me free from mistreatment by the system.

Well, I do worry about that for myself. If I outlive Mr. AOW -- and the likelihood is that I will -- nobody I know will do what I'm doing here in my home. Hospital bed in the living room, bedside potty, etc., etc. Mr. AOW and I have no children although I do have a cousin who is my designated medical proxy and heir; however, she is only 15 years younger than I am, and that's not enough of an age gap (as my mother found out with her own mother when my mother couldn't physically caregive my grandmother).

Recently, the plight of one without a medical proxy and any close living relatives came home to me when my distant cousin Mary fell ill in 2009. She had plenty of money for the best of care, yet she ended up in a terrible nursing home -- the worst one in D.C, as a matter of fact. Had it not been for Mary's neighbors, who saw their friend unfed and dirty in that nursing home and enlisted the aid of an attorney to intervene, Mary would have died in a condition that it's illegal to keep a dog in.

(continued below)

Always On Watch said...

When Mr. AOW was in the nursing home, at one point I screamed into the faces of the two social workers who had ganged up on me, "We're not 80 somethings who are going to roll over just because YOU say so! My husband and I are not done living yet!"

Having to deal with all these issues before I've yet turned 60 and come to terms with my own mortality is a nightmare in every respect that I can think of. None of us expect to face the situation that Mr. AOW and I have at such a "young" age.

The new normal that we have in this household is hideous. Even more hideous is the fact that most of our friends and family have fled the scene. Believe me, I can relate to the line from the song that says "Life goes on, long after the thrill of living is gone."

At that said, it is indeed true that Mr. AOW's condition is stable -- and improving, albeit ever so slowly. We saved and saved for our golden years so that we could travel. That ain't happening now.

I do grieve every day.

But as "a determined German," I don't give up, and I try to take what little joy I can find under the present circumstances. Were it not for blogging, I'd feel isolated in the extreme as I'm pretty much shut in the house as much as Mr. AOW is. My outings: going to work, going to the grocery, going to the pharmacy, ferrying Mr. AOW and myself to the doctors' offices. For two people who used to have a fairly active social circle, we do grieve over our losses. And the possible onset of dementia as we age is our biggest concern, our biggest fear.

Always On Watch said...

FT said: On the other hand no one no matter how he or she might be suffering should be coerced into committing suicide merely for convenience of an institution whose resources are overstrained, or by a spouse of family member who simply has gotten tired of shouldering the burden.

Amen to that!

I made end-of-life decisions for my father, who died at age 86.5. However, we had had "the conversation" some for some 10 years -- and again some 5 days before he died. Dad said to me before his last trip to the hospital, "Remember what I said. No nursing home ever."

I'm ever grateful that Dad's longtime doctor and I made the decision that Dad wanted. I could have overruled that decision as medical proxy, but I didn't. I loved Dad enough to do what he wanted. Toughest decision of my life -- until I made the decision of no intubation for my husband in 2009.

If readers glean anything from this conversation in this thread, I hope that they glean this: Have "the conversation" with some frequency before reaching old age. Of course, it's best to put those matters in writing as well. Don't leave your fate to the government or the health care system.

Magpie said...

Sorry to commit another ideological heresy here but what you’re saying is delusional, Silverfiddle.

I’ve lived all my life (well… since 1975 when it came in) with publicly funded universal government-run health care and we have among the best care in the world according to comparative studies (look it up if you don’t believe me), while spending less as % of GDP on it than the US.

You’re being ripped off. What amazes me is you want to continue to be ripped off, and come up with bizarre questions like “ Who's life is worth more, the 87 year old physics PhD who is still doing productive research, or the poor child living in a ghetto?”

What??? Trust me mate – that question and nothing even remotely like it ever comes up. All that stuff about statism is utter bullshit.
That’s what fear-mongering lobbyists want you to believe. I would laugh if I didn’t feel so much affection for your country and want better than that for you.

I’ve never felt ‘scolded’. Never indulged in some weird fantasy that better health care for all is threatening to my freedom. Just felt good that I can go to a hospital with my injuries and be taken care of.

dmarks said...

KP said: "JMJ is not a bigot."

The evidence goes against this. In discussion of the recent film adaptation of an Ayn Rand novel, he criticized one of the characters for being homosexual, and he used the word "faggot" to describe him.

Everyone knows that this word is hate speech of the worst kind. A word used by those who taunted Matthew Shepard as they killed him. As for using "retarded" as an insult to compare people to the mentally disabled, again I did provide the link. It's not a matter of PC at all, but rather of using outright hate speech.

"There's no malice here."

Do you also think there is no malice among those who use the N-word to refer to African-Americans?

Silverfiddle said...

Yes, Jez, your health care costs less, and also gives less.

When you take accidental death out of the picture (we are an adventurous and violent society here in the US), our mortality rate is better than yours.

We have the best health care in the world, which is why anyone with money comes here when they really need the care.

The problem is that the market, such as it is, is so distorted with signals distorted, that its all screwed up. We don't know the true cost of anything.

If we used care insurance they way we used health insurance, we'd file a claim every time we got our oil changed, and an oil change would cost $300.

That goes for you too, Jersey! Pull your head out of your msnbc and think outside the government-provided box you're imprisoned in.

We need more government like we need more cowbell!

jez said...

SF: I have not commented, do you mean Magpie?

Although, you're correct that I do not share your intuition that the free market would perform adequately at providing a humane level of health care to all regardless of ability to pay.

I assume that's what you want it to do. If you don't share that aim, ie you want there to exist a level of poverty where you should be denied all care, well then our disagreement is more fundamental than economics.

dmarks said...

Jez said: "I do not share your intuition that the free market would perform adequately at providing a humane level of health care to all regardless of ability to pay."

I don't either. Because some people would be too poor to get anything.

Therefore, I support a measured and moderate idea: free market healthcare, except in case where people are too poor to afford it, or indigent, or disabled. Then we would need government subsidy.

I very strongly oppose government control of healthcare for those of means. It's socialism and/or welfare for the well off and rich. For people who don't need this kind of handout.

Anonymous said...

DMarks has it exactly right.

The helpless and truly needy deserve our help. Those who are able to provide for themselves should do so.

"Equality" however is an unreal and highly dangerous concept. What incentive would there be to become rich, or at least comfortably well off, if your money couldn't buy you a measure of privilege along with better quality goods and services?

~ FreeThinke

Silverfiddle said...

Magpie and Jez:

I apologize. All you people (funny accent liberal ferners) look the same to me ;)

Yes, I want this turned over to the free market. For the truly needy, we can have a program where the government pays the premium.

jez said...

The emphasis on the "truly" concerns me a little in light of the truly excellent thread on eol. It could work, i suppose.
When the nhs came into being, hardly anyone could afford decent self-provision at market rates (and almost everyone was a vet). I'd have to do some maths to work out whether that's not still the case.

Magpie said...

“Yes, Jez, your health care costs less, and also gives less. When you take accidental death out of the picture (we are an adventurous and violent society here in the US), our mortality rate is better than yours.
We have the best health care in the world, which is why anyone with money comes here when they really need the care.”

Respect your patriotism and understand why you want that to be true, Silver, but it’s just not true. It’s a novel approach to deflect the matter by mentioning how much more violent your society is, though.
I was just saying, look at the stats that are solely about health care.

I personally haven’t been ill or injured in America, but I’ve had family who lived there go through your system and they describe it as horrific.
BTW... I’ve posted an article about the ordeal of a New Zealander caught up in it. It’s not a reply to your post, I was posting it anyway.

Silverfiddle said...

It's nothing to do with patriotism, Mappie.

Our cancer survivor rate is in the top 3 or 5 depending on whose data you use, and wait time is shorter to get care than in England or Canada, don't know where we stand against Australia.

I didn't mention accidental death as a diversion, but rather to point out how deaths not attributable to the health care system can skew the data.

Also, the differences in what countries consider a viable life lityform also skew infant mortality rates.

I sympathize with your friend. The system is over-bureaucratized, but the care is good.