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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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This one's too easy Bruce. Medicare pays for the tube and the bag. If Edna wants to continue to eat... well she better have the friggin' pesos to pay. Else, Sorry Edna... it's Ensure for you. Of course, Edna could just choose to go out on her own terms and let the pnuemonia get her.
Dying is not a bad thing. It's natural, it happens to everyone. Remember on a long-enough time-line...
Dying may be natural, but how do you know it's not a bad thing? How many times have you tried it? If it's not so bad, why do most sane people try to avoid it? Why even have medical care if dying's not so bad? Why even live?
What's all the fuss about ". . . with certain unalienable Rights, that among these are life, liberty and the pursuit of happiness"? If we're all just livestock, then maybe it is the King's right to pull the plug whenever he wants.
The problem with those of us who have empathy and a sense of humanity, is that we tend to assume that others do as well. Yet many do not. They care about one person and one person only. They will go to their $1M publicly funded cancer treatment and complain to the doctors about socialized medicine. After all, it may reduce how much they get.
You need to get back on the A-list so that you can better help people like Edna. Isn't that what they keep telling us?
Wonder who will be there when we are in Edna's shoes ... Oh, yeah, the death panels.
"That said, in less than ten-years the question of what to do about Edna will be asked and answered."
Soylent green anyone?
Bruce,
As always your posts are thoughtful and insightful. This is a most thorny issue and one that will only become more complicated with the advent of increased government intervention. For those of us old enough to remember a medical system without the system, there was only local hospitals and doctors who would work out payment for services rendered. I had numerous medical issues as a child and my parents were uninsured. We always managed to work out payment for those episodes without someone else paying.
Today I am unisured in the sense of a large corporation paying or my buying a policy through an outside provider. I use a different approach and belong to a health letter that directs my monthly contribution to an individual based on need, it works wonderfully. I had an obstructed bowel in may, with major surgery to fix it. I submitted my need of over $34K. We were able to negotiate the bills down to $13K for a cash payment and I paid everything off after receiving contributions from other subscribers, paid in full for pennies on the dollar. I have found that most doctors and hospitals will always discount for prompt cash payment. My GI Doc say he would rather get a $30 cash payment for an office visit than bill for $55 and wait for a third party payment.
DaddyO
I've not heard of this "health letter" system, but it sounds like a creative solution worth looking into!
thank you.
Needs are published in the newsletter on a monthly basis and you're sent a post card with the name and address of the recipient in need. You then send them your monthly contribution. They have also set up a catostorphic health account that works on the same principal but for major issues that exceed the $100k limit for medical issues like I had in May. To belong you set aside a $1k and it gets swept if and when your in the unfortunate situation of needing it.
DaddyO
What happens culturally when youth internalizes the new reality that there is no golden age? How does that change their decision making today?
Well, for one, it's going to cause the youth recalculate the rewards conferred by practicing delayed gratification. Dribble out this new reality one-by-one, all across the land, touching every child who might have contributed their youthful spark to society...? FUCK YOU BUDDY!
Good discussion, but can we agree to design appropriate death panels for people only if we also create them for corporations and their parasitic executives?
The cost of healthcare needs to come down. The government's involvement in this nation's health care system has led to costs that are rising out of control. Maybe other countries do this better, but you'd be hard-pressed to say ours does.
I think we'd all be amazed at how many "dilemmas" would disappear if that happened.
This is a can of worms that has got to be untangled and no we do not have 10-20 years, we are being bankrupted by the healthcare system NOW by spending one dollar in five of GDP on care, it is misallocation on the most colossal scale since the tulip mania.
First you have to untangle medical ethics from financial considerations. One cannot be allowed to drive the other or you end up in Nazi Germany where genocide started with the retarded and insane, those not "worth keeping alive." Unfortunately, we have a private for obscene profit health insurance system that both prices and rations care to essentially the highest bidders leaving the government to step in to pay for those costs private insurance refuses to, specifically the costs associated with being born and dying, as well as some other very high cost situations like AIDS, cancer, and serious accidents or transplantation. It is entirely unfair in a civilized nation to have 50 million people with no care, 100 million with substandard care, and 150 million with private care that nevertheless will bankrupt them if they file a claim or get sick.
The great advantage to socialized medicine is that it is not a private insurance marketplace or deliberately kept in shortage medical professionals that determine the prices but the buyers. Medical personnel are employees of the state, well paid and happy in those states with national care systems, but they do not get to charge $5,000 for walking through their door, or $80 for a Tylenol.
The AMA has more power in our government than all the citizens combined in this matter, and they intentionally keep medical school admissions in shortage so that doctors cannot flood the market and compete on price, they also effectively block legislation that would allow foreign doctors free entry into our medical system as that would attract a lot of really good doctors that practice because they love medicine more than their portfolio.
Healthcare dollars from government are now a fire hose of money pointed at special interests by lobbyists, the programs are so riddled with graft and corruption that everybody associated with them should go to jail. I know, I was a financial analyst with one state program for a few years, and I was disgusted with the level of fraud and the government's willingness to look away because of the federal dollars it brought into the state.
For those that do not like the idea of government healthcare all I can say is you should have been proactive in seeing to it that private gross profiteering in care was curbed many years ago, because the greed and theft we have had only makes certain that it can't go on and we will have socialized medicine because of it.
I do know that my Mom was in ICU for a month and the hospital required me to make the decision to pull the plug, they said she was vegetative and would never wake, I said wait another week. She did wake, she spent three months in rehab at a nursing home, and then came home for four great years before she died. Those years might have been bought at an expense to the taxpayers of many thousands of FRN's, but they were beyond price to her and those who loved her. It was not then nor is it now my fault that care is priced as it is, or that we are not in the 1%.
Reasonable people with decent imaginations can work together and find solutions that fit nearly all problems, this could be one of those situations, but the unreasonable voices of abject fear and hatred have to be shut out or nothing will be fixed till after it all collapses and I assure you none of us will like the state of healthcare in the aftermath of a collapse.
My question is why Edna would want to be ventilated (if you meant intubated and ventilated, which is generally the case), a far more egregious procedure to me, when she rejects the lesser evil of the stomach or duodenal feeding tube. Perhaps it comes down to what we allow when we're at death's door. She must have considered the possibility of being on a ventilator long term, assuming that the oxygen, steroids and antibiotics won't do the job this time because eventually they don't, yet the ventilator plus those modalities can keep someone going for a helluva long time. And once someone is intubated, good luck getting that tube out, even when it's clear that no more good is coming of it.
ZHers, decide how much you want done to you in the case of a catastrophic event where you can't make your own medial decisions and then look into advance medical directives. This ones not just a question of Medicare or insurance vs society, it's a question of how much you or your loved ones should have to endure.
It was my understanding that this was done to help stabilizer her. It was not considered to be permanent. She was off it in 12 hours.
No doubt, this contributed to her recovery. Like I said, they do amazing things to keep people going in those ERs.
They do indeed do amazing things in a hurry sometimes.
I don't mean to be argumentative, I'm just pointing out that this time it was temporary. The thing is, one never knows when it'll be a temporary need and when it'll be an extended one.
Once inserted, the endotracheal tube can't legally be removed if the patient isn't lucid enough to participate in his/her own care, or if there isn't legal paperwork to allow the doctors to do so. If a patient has an ET tube and their life depends on having a stable and open airway they'll die. And they need the tube if they require the assistance of the ventilator to breathe. Removing it means the doctor is directly responsible for their death so you see the problem there. The ET tube marks one of the slippery slope of medicine.
But Edna has made her choice by choosing not to decide. Every time a Medicare patient is admitted to a U.S. hospital, someone from the admissions office is supposed to ask them whether they have an advanced directive. Clearly, she prefers the full code status, and that is her business.
It is financial insanity and an impossibility to spend more on a persons health care in the end than what they may have made or earned in their entire lifetimes.
IT does not and can not compute.
Yet we continue the financial fantasies don't we?
I don't know what the anwers are to the problems. I do know that the math does not compute and those who think it does...well, it doesn't. To engage in the financial fantasy is futile and will factually be the ruin of us without even having to pencil it forward. On the face of the problem the fact remains. It does not and can not compute.
We try to justify these measures on 'averages.' How many people does it take to average out the math? If my buddy with cancer at the age of 50 has (at this point) over 2 million dollars put into his life, how many does it take not to have the same amount put into them? Quite a few. The .gov spent, get this, hundreds of thousands on my own Dad to buy him a few extra years. They spent more on him than he made in his lifetime. Same for my mother who is still alive. They are still spending on her and many TIMES more than she made in her lifetime. How is this possible to sustain?
The math on health care is just like every other segment of the .gov. Runaway and impossible to sustain.
Perhaps we can just disconnect $ to some equations? heh heh...good luck with that!
Just send me my check please Mr. .gov, and tell me what you want done. This seems to be where we'll have to end up to make all of this work because it certainly is not going to pencil out the way it's going. It is factually impossible to sustain. We face this as a world and as a country on so many fronts I can't keep track of them all. We can't even have a factual conversation about any of it that makes sense.
Edna's case is an example of an extreme. The reality is even in granting her wishes it won't change the overall facts of the runaway exponential curves that can not be sustained in the current formats.
We need better thinkers and analysts. Personally I'd like to see euthanasia as a legal alt. Maybe even write me a check for an early out...;)
ponder that the debt money / fiat being "spent" on your parents is rather like the SNAP cards JPMorgan administers for .gov - the humans are the middle-man component, just a conduit to get the monies from A to B - illness is needed to keep THIS system up 'n' running, so illness is created, via the unhealthy artificial fud-stuffs amrka is famous for. . . illness is merely the end product, funneled towards the high priest medical professionals & corporate Pharma, profits made all along the way. . .
never believe that money could be utilised better elsewhere, it is THERE because they want it there - and when they don't, the plug will be pulled.
"We need better thinkers and analysts. Personally I'd like to see euthanasia as a legal alt. Maybe even write me a check for an early out...;)"
I understand that a version of this was enacted in Russia several years ago. If a family was in unpayable debt the "old man" could contract with the government to "do him in". After the "offing" all debts would be forgiven and his wife could even remarry (sounds like something a woman would propose). This is reportdly part of their population control strategy which also included making alcohol and drugs easily available and cheap. All have worked as planned.
To extend your illogical line of thought: "It is financial insanity and an impossibility to spend more on a person's injuries and damages in the end than what they may have paid for insurance in their entire lifetimes.
IT does not and can not compute."
Society is a form of insurance, spreading the risk and the cost of many things that the individual could not pay for themselves. If you don't like that, be a hermit.
Are you willing to euthanize your mother?
When it comes to wars and bailing out banks, there is an endless supply of money; yet for Americans who have labored their entire life, paid every imaginable tax and become patriotic consumers, there is never enough-even to save their life. Just maybe, our system has its priorities mixed up.
The two wrongs makes a right theory -- brilliant. Cutting spending on military and bank bail outs is no justification for more spending on healthcare. Get government out of health care. Everyone figure out how much healthcare they want to buy for themselves and their family.
Oh, and there is no such thing as "patriotic" consumption - just patriotic saving (so you don't become a burden on the state)>
I'll support death panels for people as soon as I see death panels for large corporations and their parasitic executives. After all, if corporations are people, why shouldn't they suffer the consequences of human frailties?
This sort of "cold calculus" already exists. It's an ugly reality in a world of finite resources. What are we to do as a society - bear the cost of providing every available medical procedure for those who are terminally ill, regardless of effectiveness or resultant quality of life; or, even keep those who pass away in a state of suspended animation until a miracle cure can be found for their ills? There's not enough money in the world to do that, ergo, a line must be drawn somewhere.
Is is completely accurate to only talk about the direct medical costs of elderly? How about all the millions of people who work in industries that cater to elderly? I think you need to adjust the cost to society for the medical care relevant to the income generated by this group of 'consumers' and the addition it adds to GDP. I think it would look different then.
The main question in this article is 'where do we draw the line'. Do we stop giving medical care to people with drug problems, obesity, and other conditions that take more resources to treat?
This hits home this Christmas:
Our 77 year old mother is dying from lung cancer and may have a matter of a week or two to live. She has smoked for 62 years of her life. Even though the cigarettes depleted her life, it still hurts to see her suffer just as much as if she had never smoked. She's added enormous bills to government funded health programs. She lives in another state (her own choice) making it really hard on the family, so she has hospice services now and gets as much morphine as she wants. There are several people involved in her care, including doctor, male-nurse, social worker, the retirement community she still lives at (although it will be soon she is moved into the actual hospice home for her final days). Pharmaceutical companies have made a bundle off my mother too.
I don't think we should look at this in black and white. That becomes a meme of the Elite, who are after a human cleansing of "their" planet. (proof of Elite desire to reduce the population abounds.)
People need more power in decision making earlier on in their lives on where they want their taxes spent. We should be able to choose which percentage goes where and also have a chunk set aside for our own old age that we can decide how it will be spent and how much will be spent on our care. Making these decisions earlier on in life might help people live healthier lives, although that is no guarantee you will not have a suffering death like my mother.
People are afraid to die. We need to talk about death in more practical and spiritual ways to reduce the fears surrounding it. It seems it is rarely spoken about except when CNN wants to scare the public will brutal murders.
If your mother's condition is the proximate result of her smoking, and I don't doubt that it is, shouldn't the tobacco companies pay for her care? What is fair about allowing an industry to sell a product that makes people sick and then not requiring that industry to pay for those people's care?
The cost of smoke detectors and cigarette caused forest and hotel fires are a related matter.
If the true total cost of smoking was charged when one bought that pack of ciggies, maybe it would cause people to smoke less because of that cost. I suspect the real cost would exceed $1 per cigarette if that were the case.
feralserf - nice idea, but it doesn't work that way. i personally feel that everytime you eat at mcdonalds they should stamp a card - and eventually pay for your sents or stomach clamps. the list is endless. including every hour spent watching american idol can be accumulated to helping you get remedial education.
A card system is probably too administratively expensive and you couldn't depend on the customer to keep track of his cards. McD could just pay into an insurance fund instead an amount that reflects the dollar damage its products have done to society.
Of course, the effects on health of smoking have been known to the public since at least 1964 if not sooner. And there have been estimates that the average smoker actually incurs less cost after retirement by perishing earlier and receiving less social security and other support. So, the "true total cost of smoking" might not be quite what you expect. It's not actualy relevant, but I'm a non smoker and I've never smoked.
Should we demand that companies that make butter pay extra for the health care of senior citizens whose health is impaired by their obesity? Was there no way for them to know that being fat would harm them, too?
Fred,
When did the tobacco companies stop denying that their product is addictive? And when did they stop denying that their product was dangerous? Seriously. Do you care, or are you brainwashed into believing that big corporations are all good? Really....
Butter is a historical food. It's probably not a significant cause of obesity in itself, though it's definitely possible to become obese by consuming it. Margarine is probably worse. A much larger societal obesity (and diabetes) problem is the amount of high fructose corn syrup in Americans' diets. And yes, I think that appropriate taxes on that to pay for health problems due to its consumption is fair. I avoid it personally and I believe that people that there's nothing wrong with rewarding people that, through their lifestyle decisions, lower their health care costs. The best way, IMHO to do that is to fund insurance out of the proceeds of the unhealthy activity.
The political process has allowed large corporate contributors to avoid paying for the cost of damages that they have done to society.
"Margarine is probably worse."
Set some margerine and butter in separate plates on the counter and observe. House flies will go to the butter, not to the margerine. I would question if we should be eating something that a stupid house fly doesn't even want. I would remove the "probably" in your sentence.
Merry Christmas!
feral serf and debt is not money - correct. there is nothing wrong with butter in terms of eating it or health. or bacon or steak or eggs or anything else. it's a question of how much. when i was to dinner with the most beautiful women i knew in paris - they had steak, fries, some vegetable, some salad (with NOT lot fat dressing), red wine, dessert was chocolate cake and NOT a decaf expresso. and sometimes a cognac. i forgot the raw oyster appetizer. the wost thing anybody can do is put the fake stuff into their bodies. it contains NO nutrition and since the body (and brain - we forget that one) are starved and only thing one know is to eat more of the same, the body begs for nutrition and guess what - more margarine and coke and mcd's goes back in. and then the body goes - OOOOOOOOOOOO000000000000000000
merry christmas to all. i give up. really, mcdonalds and coke and exxon won.
Ya, I think the tobacco companies should be forced to pay for all those bills smokers incur. But it would get complex because the companies would say her lung cancer could be from something else, or they would pay their politician friends to their favor, and on and on. What about junk food companies? and companies that contaminate food? How many deaths is that causing and how much does it cost taxpayers? Where does this all end? It will end up the governement will establish guidelines on who gets care and who does not....already they do this to a degree.
What about the taxpayers in New Mexico who are on the hook for that private space station that will carry wealthy people into space? The way they get around this is they say it belongs to the New Mexico taxpayers, yet how many of them will get to fly into space? These private space stations are cropping up around the world. Only select people who can afford it get to use it. Will the taxpayers benefit? I doubt if most will see a dime of that.
the list goes on in this entire dilemma argument.
Like someone else says, it is all about priorities.
In any system, there's ones that fall through the cracks. If tobacco companies paid for all the lung cancer cases, there would be some that got benefits that weren't the result of someone smoking. (Not all smoking related illness is contained in the smoker population -- some non-smokers get smoking related diseases due to second hand smoke.) There would also likely be some that didn't get paid from the tobacco "insurance fund". 100% results are rare in this sort of thing, but 90% may be a possibility.
Junk food companies are a logical extension of this philosophy. And where does it end? That's what society needs to decide. The answers won't be the same for every society. My own preference is to not subsidize tobacco and junk food companies. If you eat or smoke something, you should pay the full cost of that activity. The same should be true if you like to race motorcycles. You should be able to do that, but I shouldn't have to help pay for it.
same with twinkies
coke and pepsi
charge a fee that pays for health related costs
tax white bread , pay in advance for all toxic food .. which is agout most of it bought in the supermarkets of today
have an entrance fee for all supermarkets.. to pay the health related costs
all fat people over 100 lbs normal rate pay a higher rate for food double their cost for food and set aside for health costs
have a scale in the door way of all supermarkets , cafes , food places double the price for the glutten factor.
not to mention whisky and booze fee for death and sickness
not wearing condum tax .. for aids related death ..
This is precisely why government needs to get out of providing health care or health care funding all together. There is no end to the State's interests when government is involved in health care. They can mandate almost anything on that basis -- a form of government I thought we defeated last century.
hey dumpster - i love you! and you know what - anybody too fat to walk isn't allowed to drive a car until they can walk.
hah - hah - hah
Absolutely in the case of twinkies and especially soft drinks! They are a big contributing factor to the costs of health care.
Entrance fees to supermarkets make no sense. How is one to obtain food? Not all food is equally toxic. People, including the fat ones that consume more, that pay extra for soft drinks may consume less of them.
There are already large booze fees in effect.
If AIDS was invented by the CIA, shouldn't The Company pay the costs? It could come from their heroin and cocaine profits, eh?
Typical progressive. The Federal Government is already consuming somewhere over 20% of GDP while these gansters claim the they are only running $1.5T budget deficits, and the progressives say "America can pay for it". Bullshit, you progressives have destroyed the future for multiple generations by your refusal to even consider the meaning of "private property".
So does Edna own the home she lives in? Does she still have an inhertance to pass on to her children while she busily loots the rest of us? I know the attitude well, John Corzine has it too. Who cares about every one else when the government is stupid enough to let you get away with robbing everyone else.
Edna has no money at all. I help her. She gets $740 a month from SS. That does not go far. She rents and owns next to nothing.
My inlaws own outright a house worth at least half a million that they bought for $30k and is still under prop 13 and both have Ventura county employee pensions that include all kinds of health care perks. Both are over 80 and have had so many expensive treatments that I lost count years ago. Like Edna, they had the good luck to have entered the ponzi scheme at the beginning. Like Edna, they started with nothing and neither are even high school graduates. I flat out tell them to their faces that they are looting. The response is "what do you expect us to do, turn down the free heallth care". Every one of these SS looters gladly accepts benefits that far exceed anything they paid in and yet they love to complain about greedy politicians, capitalists and anyone else that is richer than themselves. The first thing the country has to do is to stop the looting.
ConfederateH -- where is your moral outrage over the trillions taken from the middle class by the military industrial complex and the bankers? Are they okay because they wear flag pins? Fuck you.
i can see how doctors and the pharm industry are going to be seeing lower profit margins.. not even the government can afford to pay them anymore.
So what this story is saying is that Sarah Palin was right about death panels. Even more so is that this story confirms everything those of us have been screaming at the top of our lungs that socialized medicine doen not work unless you are the one that determines who does and who doesn't get care. Wanna take any bets that the gov't fucktards will get the best care over their citzens who pay for it? Just like in the former Soviet Union
Palin said nothing about this subject. She used "death panels" to describe the provisions in Obamacare that would reimburse doctors for end of life counseling.
You saved me the trouble of pointing that out. And, by the way, we already have death panels. They are called Insurance Companies. They decide who gets treatment and who doesn't.
. . . they also decide who gets insured, and who doesn't.
RockyRacoon. Thank you for that. Once again, a brutal gang of facts kicks the ass of a (not so) brilliant theory.
Merge in cost sharing.
Medicare currently pays 80% when you first enroll, every decade have it pay 10% less.
This way when you are 75 it pays seventy percent,
When you are 85 it pays sixty percent, and when Edna hits 95
It pays half.
That way she can make a choice.