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Edna
At around this time over the past few years I’ve written about the posh holiday parties I went to. No luck this year. I went from the A-list to the Shit-list (I blame the blogging). So instead of eating fancy canapés and talking with very important people, I went and saw Edna.
Edna was born in 1918. She’ll be 94 years old in January. Her mother died young, she went to a home for children when she was eight. In 1936 the home went bust due to the depression and a shortage of donors. She has interesting stories of what it was like to live in Jersey City during the second depression of 1937. She remembers where she was when she learned that Pearl Harbor had been bombed. Her husband went to fight in Italy during WWII. She lived an average life, and enjoyed every minute of it.
Two years ago I got a call from an Emergency Room. Edna had arrived in an ambulance. She could not breathe and they were going to vent her. I thought it was over. Not the case. Five days in the hospital (steroids, oxygen, antibiotics and 24 hr. care) followed by twenty-one days in a rehab and she was back on her feet.
Edna’s medical problems were caused by old age. There is a valve that allows food and water to flow to the stomach, but blocks it from getting into the lungs. Edna’s did not work well. The result was "aspiration pneumonia". She had two failed operations operations to repair the valve.
There is a treatment for this. They poke a hole in the patients stomach, put in a tube and tie it to a bag that the patient wears on her on hip. Ensure gets fed to the patient via the bag. Nothing goes down the throat. Problem solved. Edna wanted no part of that.
Edna’s been to the emergency room/hospital a total of six times since that first episode. She averaged four days each time. She has had two operations and spent seven weeks in rehab.
The medical profession can truly work miracles these days. This woman should have been dead (at 92 years old) when she had her first episode. If this were 1981, she would died.
With each brush with pneumonia she was advised that she should opt for the bag. If she didn’t, then she would get sick again. I spoke with her about this on several occasions. She told me the same thing she told her Doctors:
No bag! I’d rather be dead then not eat or drink again!
I can’t blame her. But there is an ugly side to this. Given the cost of the treatment (100drs of thousands?) over the past 24 months there are questions that society has to ask Edna. (1) Does she have the right to say "no" to the medical alternative? (2) If she says "no", does society (Medicare pays for all of Edna’s bills) still have to pay for the repeated hospitalizations?
In 2011 the answers to those questions are "yes" and "yes". No treatment is without patient consent and every hospital would put out a maximum effort if she were wheeled in the ER door again.
America can pay for Edna today. She is a very small percentage of the population. We are still a wealthy enough nation that we can afford to give Edna the treatments and the choices. That will not be the case in ten years.
America’s population is aging very rapidly. There will be a bulge over the next twenty years. I’ve looked at these numbers. They are out of control. I don’t think it’s possible that the country can provide the level of care that Edna has gotten to all of those other Edna’s out there.
The Edna story is a death panel story. It’s a horrible discussion to have. Does Edna, at 94, have the same medical rights to make choices as does a thirty year old? If you say no, how do you respond to new knees at 77 and new hips at 84? When you start drawing lines, it’s very hard to stop.
The easiest thing to do about this is nothing. No one wants to touch this hot potato. I can’t blame them. That said, in less than ten-years the question of what to do about Edna will be asked and answered. In the end “she” must lose some of her rights. For the life of me, I can’t figure out how that can be accomplished.
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ouch...has the ring of truth...man is his own perfect killer...question ... if you give someone an extra ten years of life because of healthier living/life extending medical care, are you entitled to say when to start the downhill run to a "painless" exit? I try not to think of whether the dying person has awareness of the "murder" method.
You've got hugely inflated prices of health care. The doctors in US are greedy as nowhere else in the world.
Meanwhile the race for the buck turns the average US citzen into a stressed rat and consequently a victim of the "health-care" machine.
Travel a bit! See what the health care is like outside of the US!
Ecuador - first class medical facility and US trained Doc. Full physical exam, full blood chemistry workup including PSA, cardio stress test by an actual cardiologist, abdominal ultrasound, endoscopy, x-ray of neck for old cracked vertabrae from high school football, pre- and post exam consultation with the actual doctor, and one hour massage - all in one day for $420 cash.
AND no report to all the US health care insurance databases where you are blacklisted for life for coverage for a "pre-existing condition" God forbid the testing actually turns up something.
Where else in the world would a new med school grad start his new career with $275,000 in debt and that's just in student loans not including 10 years of credit card debt accumilation? The US had promised riches for those going to med school on borrowed money. Those days are over...it's simply just math...and "free" unlimited quality care? ...going the way of the Dodo. We will soon have multi tiered healthcare...if you have the means to pay, you'll get those new knees at 75 if not, it'll be Soylent Green.
Switzerland...don't need a doctor, take homeopathic remedies from local shop.
Yugoslavian (Croatia) coast, north of Dubrovnik...the doctor will be charming and take you to dinner on a terrace overlooking the Adriatic. No charge.
Paris.........best to have air conditioning in summer if you're old, you will never make it for medical care.
London....faster to drive to Germany and see a real doctor.
Canada... Go to nearest shopping mall, walk into clinic, ask to see doctor, wait about 2 minutes, see doc, pick up prescription at same location. Free, of course the doc is East Indian and you can barely understand him.
China, near Bohai Bay (NE/Manchuria)
Bronchitis and severe coughing & head congestion.
Hotel staff noticed I was sick. Free physician sent to my hotel room to check on me. Chi gong treatment (energy/hand waving over head and chest), instantly cleared sinuses, went to bed, much better next day.
Florence, Italy
Severe coughing & bronchitis, walked into Italian pharmacy (pharmacist trained in US, spoke English), explained symptoms, less than $5 for antibiotics. Took less than 5 minutes, much better in 2 days.
Lima, Peru....fall down stairway on ship, ambulance from cruise ship to hospital, ER admission, 1 night in 5 star foreigner hospital, x-rays, MRI of head and neck, 4 physicians (all trained in US and speaking English), multiple tests, medications, round the clock personal nurse.
Total cost under $200 USD (paid with Visa card at checkout) and this was the highly inflated foreigner tourist pricing... locals would not pay nearly that much.
Geez - judging by all the Edna hand-wringing & emoting here, you'd think no-one had ever croaked before.
Edna is entitled to as much pain medication as she needs and sympathetic hospice care.
Being from the UK and retired in the Philippines I can compare two extremes of medical care.
Clearly it is desirable to provide as much care as possible to prolong and enhance life but practically not at ANY cost.
The UK system gives "unlimited" and generally "free" (actually paid from higher taxes and living costs) access to health care. Regretfully this is inefficient and causes a great deal of unneccessary expenditure and waste. However the budget constaints imposed by health authorities have created a system where it is now the employees within the system who are left to discourage or fail to inform (largely uneducated in available treatments) patients what would really be the best for them, THUS the NHS has deniability should it be claimed that they do not provide the best care available and will point the finger at individual employees for failing in their duty should the Kaka hit the fan in particular cases. That said my opinion is the vast majority of patients get the treatment they need in a reasonable time.
The Philippines has a multi tiered system. the 10% or so who have wealth get the best possible treatment (at inflated costs for the region but money is no object) The 20% middle class get care via insurance schemes but this has low caps and normally some cash participation from the patient in any event. The level of financial support will not provide for any prolonged treatment nor for the best available. The other 70% of the population have very limited access to even basic medical care ( and vacination which only compounds the problem) and any life threatining illness which has requires an expensive cure virtually guarantees death for the vast majority.
HOWEVER
The predicament they find themselves in has a silver lining.
1 They majority practice cleanliness both in personal hygiene and the environment they live in almost to an obsession as being sick is not affordable.
2 They watch diet and exercise and arguably have a healthier lifestyle than those in the West. ( yes lack of money is also a factor)
3 Even with limited education many can talk knowledgably about the efficacy of medicines (and generics) or whether tests (MRI..2decho etc) are cost effective for the medicalcondition they may have.
My conclusion is they are better informed/aware than their UK counterparts who mostly are blissfully unaware nor particularly interested until they have a complaint or serious medicalcondition.
Here is the point
The death rate in the UK is 9.33/ 1000
in the Phils its 5.02/1000
in the USA its 8.38/1000
(yes demographics etc may spin the figures somewhat but the range is clear)
http://www.indexmundi.com/g/r.aspx?c=xx&v=26
But the per capita spend on health care is (2009)
http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditu...
UK $3,487
Phils $ 129
USA $ 7,960
This suggests that the West (and the USA in particular)may not be getting much bang for its buck.
If per capita costs in the USA could be reduced by 30 % without significant adverse affect on mortality (agreed quality of life is not taken into account but mortality could be considered a mor important indicator) or even reduced mortality, Then the Edna's of the USA may be able to receive all the treatment they need until they eventually move on to the next Astral plain..
Where do those savings come from?
Reduction (not elimination) of Corporate profits, fees , limits to insurance Fees and awards. Education with focus on prevention and health awareness would be a start and POLITICAL WILL to tackle the problem .
I am in no way an industry professional but given the figures it just seems that its common sense that somebody is paying twice (or 60 times) as much as the rest of the world for no better or even worse results. There will still be some Edna's with other afflictions which will be too expensive to help but at least more can be provided for and the debt burden could be reduced.
exactly....brilliant comparative facts
exactly....brilliant comparative facts
Excellent. It's not who pays, but that we pay too much.
How's that different from defence, government, financial services, insurance and a host of other services in America?
Politicians love social issues loaded with emotional baggage as they help confuse the populace, reinforcing the 'need' for political 'leadership.' Socialized medicine is the ultimate socialist/emotional meme, due to the rather unnatural fear Western civilization has towards death. As others have already pointed out, there is no 'we.' There is no entitlement to steal from society for personal gain. Everyone is entitled to all the health care they can afford, and no more.
Yes it is tragic that people die, but socialized medicine (or any other system of health care delivery) will not change that fact. While it seems unfeeling, unfair, somehow not right that poor people suffer, remember that until about 100 years ago, everyone suffered, as medical science has only very recently begun to make serious progress towards life-sustaining treatments and procedures. As with every other type of financial good, the distribution is not uniform. That politicians would have us believe that distribution 'should' be uniform is the basis of the drive towards socialistic policy. Please note that the politicians are not really for socialism; they may claim that they are striving for that target, but they always seem to miss on the side of fascism, or, in our current case, reverse fascism. This socialist meme is thus fraudulent in its purpose as well as in its foundation. The obvious purpose of the US approach to socialized medicine is to create the environment in which monopolies are accepted within the delivery system, thus guaranteeing the diversion of huge amounts of public money to a few select, connected, crony capitalists. It was not coincidence that the president of a health insurance company received $145 million in 'compensation' last year (the biggest personal haul of all the 1% elite). This increases costs and actually decreases the total amount of health care provided.
While no system of health care delivery will ever be 'fair' or uniform, socialized health care is the worst possible mechanism. Not only is there no 'we,' there is no justification for the government to be involved in healthcare at all. Finally, as Thomas Sowell stated “It is hard to imagine a more stupid or more dangerous way of making decisions than by putting those decisions in the hands of people who pay no price for being wrong.” When the consumer can demand services paid for with 'other people's money,' of course he will accept every health care service available. Thus health care costs will rise without limit. This is a nice outcome if you happen to control a monopoly on service delivery, but it is a formula for total failure as a public policy. Ultimately our present system will have to be scrapped entirely, or dismantled slowly by increasing the co-pay fraction. However the present system is dismantled, the result can only be improved health care for society as a whole.
Fishhawk
Maybe we can come up with a plan to just exterminate the aged? Its been tried with various populations. How did that work out? Maybe we should just drive them out into the wilderness to fend for themselves thus assuring a premature death at little or no cost to society? How about we stop the piratical rise in medical cost first? Not every doctor has to be a multi-millionaire, stop performing unnecessary or dangerous operations, not every drug company gets to sell crappy drugs at ridiculous prices, not every employee of the FDA needs to be a captured regulator for the medical industry to increase profits at the expense of the patients. Control the costs and you solve the problem of paying for the aged.
You make the unfactual assumption that people on Medicare get usual and customary medical care...they do not, there are many restrictions compared to other medical insurance coverages.
That is not to say Medicare is not rife with lunatic billing expenditures created and controlled by our federal governement. A small example is the protection of big pharma in the pricing of prescription drugs. But, our government is protecting these wasteful expenses and insulating these big businesses from being competitive and radically cutting prices by approving and regulating the cost of specific drugs. Esentially the federal government sets the price of drugs in the US based upon what Medicare will pay. And, Medicare pays/schedules how much they allow to pay...way too much. But nobody does anything about it.
Medicare is not providing adequate medical care to seniors while paying for highly inflated expenses that do not improve the medical condition or life of the senior. Example, weakness in walking after hospitalization.........$250/hour for physical therapy paid by Medicare when a qualified personal trainer with a degree for $60/hour could provide a far better muscle tone and performance outcome. They bill the $250/hr but do not produce results a trainer could provide for much less money.
The minute we assess a monetary value to human life whether old or young, it becomes a slippery Teflon coated slope to apathy, indifference and eventually removes the underpinnings of what it means to be human. A perfect example of this in a supposed "civilized" society would be the running over (twice) of Yue Yue, the 2 year old in China who was ran over twice and had up to 18 people pass by without much, if any thought of assisting her. The reasoning; it would have cost them to assist her whether she lived or died. Perhaps it is the ultimate gauge of a society's humanity, I am not qualified to judge, only to make observations and am of the thought that when we assign value to a life that has more years behind than ahead, the next logical step would be to assign a value to the handicapped, the disabled, the terminally ill. Unfortunately, it would not stop there and might eventually include the non-productive, those with green eyes, etc.
no one is qualified to assign the value of another human's life
therefore, equality for all
and give each person the individual freedom to chose when they live and die
Ah, didn't take long for the old "slippery slope" non-argument to popup its hoary, deceitful head...
So, let's see: you don't want to have to make a difficult decisions, so therefore nobody should be able to make a difficult decision--and we should all go down with the ship, regardless of our culpability, because, well...yeah, why, exactly???
Narcissistic pinhead...
Bruce, you really know all the right people :-)
If we are serious, we must say that already today Edna can only get that over-generous care because some other old folks refuse to try those expensive operations with low probability of really fixing things, and die quietly and a little earlier.
We all know how it will be solved: medical care will be limited either through increasing costs to the individual until most cannot afford it anymore (the capitalist solution), or through increased waiting times for the "free" care until the waiting line is measured in years and people die off before they get treatment (the socialist solution).
Propagandists foaming about death panels are only trying to obscure the matter that one or the other way will be taken.
<<America can pay for Edna today. She is a very small percentage of the population. We are still a wealthy enough nation that we can afford to give Edna the treatments and the choices. That will not be the case in ten years.>>
If the Ednas of America are euthanized, why do we need to produce so many health care workers? And what do you suppose those people will do for work? Advanced health care is really paid for by technology. As a society becomes more productive through automation, among the benefits should be better health care for its members. Bankers and other useless eaters at the top shouldn't get all the rewards of this.
I'm going to Germany next month for a procedure that costs about a third as much as the same thing costs in the U.S. or Canada. Why is that? The average German gets paid more than the average American or Canadian. The Germans get much better care for their "dollar" than Americans do. The same is true for most Europeans. There is nothing substandard about German health care compared to the North American variety. I suggest American health care is priced far above comparable (or better) health care in the developed world and that there needs to be a wholesale restructuring of it starting at the top. There's too many "useless over-eaters" in the American health care system.
i'm really not sure what the answer is. my father was on dialysis 3x a week for almost 5 years - the cost was huge - just the transport back and forth. he would laugh that they had spent more than he had ever earned in 50 years working.
but - what's the point? it's all funny money - just like the cds market. just numbers. it creates a huge amount of employment - from the relatively low skilled transport workers, nurses, doctors, people manufacturing machines, devices, testing lab results.
and...if the people receiving entitlement programs and extended unemployment payments were required to WORK to receive their money...........our senior nursing home and medical care expenses could radically drop in actual cost.............a win win for everyone, they get money & they also are productive and cut the expenses of caring for our senior citizens
This is a good article but it's kind of awful on a Christmas day, to discuss the (probably necessary) limits on expenditures for the very elderly folks. I only gave it three dots.
I wouldn't put my sons a half million in debt to keep me alive for a year or two. I would opt for the pain-killers and to go home. Being lower middle class teaches us to go without things that rich people can have. It's just how it is. No big deal.
The Good Lord has a special place for the poor at the head of the table, so it all works out.
Royalty have so much, they should foot their own medical bills. They should start studying the 'camel through the eye of a needle' parable as well.
Yep. But this is the best day to have this article posted. It is not about life and death, but how to live, and how to die. I will choose both myself.
conax - nice one. nag hammudi translation. i think most of us still think it is a 'rope through the eye of the needle'.
lotsoffun,
The eye of the needle is a translation for the name of the gate that travelers came into after dark. The main city gates were closed, and the only entrance to the city was via this narrow gate, so small that you had to unload your camel in order to get through. This was intended to defeat armed intruders from getting in. Thus the intent of the biblical saying is to say that the wealthy has no better chance of getting into heaven than a loaded camel; although only one can be considered as a "loaded ass".
thanks. that sounds like fun.
it can be simple..........allow everyone to be treated the way you would want to be treated...with respect, dignity, freedom of choice and no difference in medical treatments based upon age, sex or ethnic origin
Merry Christmas Bruce!
I always enjoy your contributions.
As for Edna, the hospitals and doctors will continue to recommend any treatment for which they have a reasonable expectation of being paid.
Even "The Oregon Plan" which purported to be the application of cost benefit analysis to medical procedures was instead designed to increase the number of oregonians entitled to medical coverage.
http://en.wikipedia.org/wiki/Oregon_Health_Plan
and I have a bridge in Brooklyn to sell you
B.K.
You have my respect. I don't care if you consider that respect valueable or not. I respect your thoughts and your opinions.
Please keep sharing them and enjoy the holidays as best you can.
Robert
Where are the articles talking about this dilemma of health care for elderly when it comes to Prince Philip? The 90 year old had to get a stent in his heart. How much does that cost the taxpayers? How much has this family cost the UK taxpayers over the years? Why is this question not directed at Welfare recipients such as these royals?
It is always directed at some "nobody" elderly man or woman of poor status. The royal family in UK just takes it for granted that they will continue living on millions of dollars funded by the common man and woman.
Much of the health care industry in the US is geared for keeping people in poor health, because its a money maker for some (there are some that say the cure for cancer is already available but being blocked...not sure but its something too look into). I think this entire subject needs to be evaluated in another way, besides deciding who is worthy or not.
A couple people keep talking about the math not adding up. But you can't look at this in just the cost of care way. We need someone that can dissect this issue and come up with an actual cost to society for these wealthy people like the royal family compared to the individual common person. I think when you do it in a "per capita" baiss we might find some very surprising results.
You have to take into account all the jobs that it creates.
Also look at people like Jamie Dimon and his scamming company. Are these bankers right when they say that they create benefit to the communities? When you add in all the banking welfare, derivatives, and then the jobs it creates, is it worth it?
ummm the queen pays taxes like anyone else (and also uses public transport now), on the income from her land and estates, there is a civil list where she is paid to represent the country. i doubt very much whether the tax payer had anything to do with paying for prince philips stent. major point, whilst it is true that the queen does sign every statute into law, she drafts none of them, and if she refused to sign just one, there would no longe rbe a monarchy. it is odd that americans still believe that the UK is run the same way as it was in King George's time. It is a socialist state, with a (highly educated) monarchy and an international banking centre. it hasa few good supermarkets, insurnace companies and telcos, and a great sense of humor, but, really, the queen has no power, authority or discretion, merely a capacity to advise sucessive prime ministers who have weekly meetings with them.
heh,
tell it to her son, prince charles. . .
Where are the articles talking about this dilemma of health care for elderly when it comes to Prince Philip? The 90 year old had to get a stent in his heart. How much does that cost the taxpayers
Not sure, why you have a problem with that. It is his wife's country (literally), and all these taxpayers are her loyal subjects. It is their duty to pay taxes to the sovereign.
LOL!
Maybe it’s your duration. re: Edna – there’s no way to a MUCH lower standard of living without a lot of PAIN. We are facing the shadow side of Alan Greenspan’s “WEALTH CREATION.”
The point is to realize death is not the end. Never has been, never will be. It is something we all share - mortality.
Edna made her choice, can we allow her to die and move on? Or is it our own fears that are manifested in this story?
On this day a Savior is born, tis Christ the Lord. Live long, love well.
our own fears - which is why the christians refused burials of suicides with the others - you need to stay and suffer to the end with the rest of us.
No comment. I like yours though Bandgap.
I don't fear Christians/Muslims/Jews.
I fear those who have no power greater than themselves.
I have given this potential situation a lot of thgought.
It is impossible to say how one will react in the future.
I have a living will, which details the situations in which health care should not be provided.
In addition, let's say Medicare does provide coverage, and it would cost $250,000.
In lieu of medical benefits, I would refuse treatment for a $125,000 death benefit for my heirs.
Don Levit
Along that line of thought, perhaps we could or should sell both of our kidneys, our heart and our eyeballs and any other parts the docs can find to pay off our student loans to Jamie, eh? Some say that's happening in Israel, i.e. they're repossessing the palestinians' body parts.
It would discourage going over your limit on your credit card.
Ah, mortality, the great leveler. As the mast head says "
So. my ex was a nurse and we discussed this scenario many times. It's called a "Living Will". It's where you put down in writing just what level of "care" you are willing to tolerate before the "plug" is pulled. (have it notorized)
It is the greatest gift you can give your family, the gift of not having to make those excruciating decisions for you.
As Jenna stated above "And once someone is intubated, good luck getting that tube out, even when it's clear that no more good is coming of it."
Sometimes dying is just the right thing to do.