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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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<<Everything has a useful lifespan . . .>>
"Useful" to whom? Themselves or someone else? When you're no longer useful to me, I can pull your plug? (Jamie Dimon has never been useful to me....) People are not dogs, at least in my view. Your dog's arbiter is you, his owner, which gives you certain rights and responsibilities. If people have owners, then perhaps it is their owners that should be the arbiters? If we own ourselves, then . . .?
It sounds to me like Edna has not reached the point where she is useless to herself (and maybe even a few others).
(somewhat) randomly jumping in here. . .
we all owe it to ourselves and those we care about to get right with what we seek as an "ending" - and the when part as well. . .
this is dealt with in what western culture likes to see as "primitive cultures" - archetype is the elder knows it is "time" and with ritual, absents from the main tribe, on their own final journey, much like the dog in the story above. . . we are so out of touch with our time/space, and so enamoured of "being" at any cost, that a respect for the living, by allowing our our own death, and doing so in a way that brings peace to all present (irrespective of loss, which is in reality, a personal thing) rarely happens.
it is each of our responsibilities to accept the inevitable, and even make preparations for this - not just a will, but a discussion with someone we trust to carry out our wishes when the time comes.
organ donor, do not resuscitate order, even a personal "wake" - whatever, from your point of view.
it's past the time to have this discussion with "Edna" - she's most likely set in her ways now - it needs to be done when ill health is not on the horizon, so that the decision is a considered one, and includes gratitude for the life lived. . . it's just a letting go. . .
Sometimes the magic works... sometimes it doesn't...
http://www.youtube.com/watch?feature=endscreen&NR=1&v=uLso0ZBqOi4
Like most Ayn Rand types (narcissists), many here view other human beings as dogs/pets. When someone (else) is old and needs medical care they can't afford, let them die. When the narciissist Rand worshiper becomes old and faces a health crisis, the self-serving Ayn Rand double standard kicks in. He assumes he will have the ability to pay for life saving treatment. If he does not, it's because someone else took his money and he will expect the suckers to keep him alive. Know that, and know everything you need to know about those who follow Ayn Rand. P.S. These people run the world.
Only in the modern age do we have this kind of luxury...
Agreed, The pet business is a $50 billion industry. It is absurd. And I am suppose to pay for the pet owners health care and Social Security because they spent it on a pet?? There are people all over the world who would love to eat as well as our pets. But it all makes sense since most believe in the moral equivalence (or close to it) of dogs and people.....sad.
Not on Christmas dude. come on
"But what will become of the elderly who cannot care for themselves?"
Chodorov answered: "They'll be allowed to die in the streets as was done in the past."
The questioner then asked: "When was that ever done?," and Chodorov came back: "Precisely!"
no liberty need be lost to fix the healthcare system. the "system" must simply be abolished, by showing the proper respect for property rights. the very idea that it is a "system" is anathema to moral uprightness.
the superstructure of society is culture, propagated through the family and the church, not a politically directed organization from the lender on down, or from the regent on down, and not propagated through ideology. contract is everything because covenant is everything.
you clearly do not even begin to understand the problem. there is no "we."
Jon -- well said. Liberals (Dems and Reps) have convinced the masses to look to government for whatever they need or want. Liberals want to stifle personal responsibility and the family unit for that matter because these things hinder the true supplier of all needs, our savior -- the government. So local charities and taking care of one's self and family are diminished as the masses all worship the great Provider in Washington DC.
Once government decided that all hospitals MUST treat anyone who shows up in the ER with the best care available regardless of ability to pay, the battle was lost (anyone know what law required this??). From there it is easy to get to Obamacare and from there it will be easy to mandate many things that will be in the State's interest because it impacts health costs.
Liberals think they are more compassionate and therefore have a higher view of people. The reality is liberals take a very low view of people -- believing the average person is largely incapable of finding owns way through life and not able to deal with adversity without the full throated assistance of the munificence of large scale government. Sadly, most Americans have become soft and lazy, entitled victims who now believe they NEED to look to government for their provision. We have lost our culture -- government usurped it.
Wow, listen to Rush much? Try thinking for yourself. It is "libera"ting.
Actually no - I work for a living - trying to make sure me nor my family is a burden to anyone - including you. Something I encourage for all.
Instead of sophomoric name calling, please address your seeming contrary position that people should increase their dependence on government (i.e., other people's money) or that government needs to provide exanded services to take care of most. Please include a discussion as to how this might impact GDP and productivity (assuming you believe some laws of economics (i.e., people respond to incentives) actually exist).
i think you need to keep in mind the "equivalence" of terms in an evolving society. people may not be dying on the streets,but if you view these streets as hospitals,with wards and wards of streets, you get the idea. similarly, soup kitchens have been replaced by food stamps, 47 million of them, almost double the number that lived in similar povery in the 1970's. insitutionalisng the issue means new metrics need to be applied. "we" allow the solution to evolve and make it look "acceptable".
Right on, man. Right. On.
Jon, one of the best posts I've on the internet. Truly a thoughful post.
Well said.
Is it possible to unwind what we have and just assume that Chodorov is right?
When did he say those words? 1950's? He died in 1966. Society is much different today. Older people will not die in the streets. That will not be the result. But I would not assume that those churches and families are going to fill this hole.
I think it's very hard to get from "here" to "there".
With "catastrophic success" in extremely early detection of cancers at $100 per annual blood test only a year or two away, a huge longevity boom is about to explode in a medical system that can't handle the current longevity curve. Bruce's moral dilemma is about to go exponential in the USA and the rest of the aging developed world.
The morality of shoving the old folks out on an ice floe is going to be challenged everywhere by old folks everywhere. With some merlot and Viagra, what's wrong with this picture will be a new AARP magazine topic review.
I've seen the world's population double in my lifetime and I don't think we'll see another Green Revolution multiply food production like we did in the 1970s.
A good investment is a few acres of good south-facing land (in the northern hemisphere, water and knowldge in square-foot gardening techniques. Train the younger generation, save open pollination seeds (grow your own)
The current Green Revolution depends upon cheap oil for farm machinery to dramatically increase farm labor productivity, fertilizer feedstock for dramatic increases in fertilizer usage, and food transportation (California lettuce in New York, Chilean grapes in Seattle). If we are at Peak Oil and oil soon becomes much more expensive, current rates of global agricultural productivity could well drop significantly, while food transportation costs would go up. If the current Green Revolution fades, the ability to sustain the existing global population would drop commensurately. We will be lucky to sustain current levels of food production. Agree another Green Revolution further multiplying food production seems very unlikely.
Churches and family and charity did a good job once. Then government decided it could do better and started throwing taxpayer money around like it didn't matter. How much more health care could be purchased with what medicare wastes each year? And in a for profit environment, they have an incentive to prevent theft. Not so the bureaucrat, his only incentive is to get from start date to retirement date. The congress' only incentive is to get money to friends to get a taste back for re-election. How many California incumbents have been turned out over the last decade?
Some of you people need to read a history of the Victorian era if you think that the poor and the elderly were well taken care of prior to the so-called "safety net".
I do not have time to get on my soap box, but I do want to throw two things out there.
First health insurance is NOT insurance. Car insurance is insurance. Car insurance is about risk, not certainty. Health insurance is about certainty, not risk. This is the gist of Bruce's post.
For those that did not follow, the odds of wrecking a car are generally the same whether the car is new or 10 years old before you sell it. So auto insurance is about risk. In health care, as this goes, the odds of a wreck greatly increase as the car gets older becoming almost certain by the time its 10 years old.
So, insurance is a bad word from the get go. Let's call it "health cost redistribution" because its more accurate.
Regarding your notion of government involvement, I would suggest the current system started with the genesis of health insurance back in the ... 50s? ... for teach unions I believe it was, who negotiated collectively for access to hospitals at some sort of agreed upon rate. I believe the first of these was Blue Cross or Blue Shield (one was doctor, one was hospital?). Anyway, this model expanded and and expanded and led to the insurance system we have today.
But the demographics were overwhelming younger. Or, per my previous horrible example, all the cars were 3 years old. So, the system grew only because of the distribution.
That distribution is changing and Bruce points out quite fairly the end result.
Lastly, I want to say that I sponged the system when I was in my second (third?) year of college as an engineering student. 100% lung collapse, I was in the hospital for two weeks. I had a talc plueruodesis operation because it wouldn't heal. I think just the hospital bill alone was 20k (1995?). Anyway, I was driving a beat up VW bug that I kept running, was working part time, and going to school full time.
I didn't pay the tab. I like to feel I added lots of value to the world since then. But, if I was 92, I don't thinks a wise investment anymore. If I had the choice for care, would I take it? Hell yes. But I won't. This system will be long gone by the time I am 92.
So, I eat well, live in a clean environment, and I suck up every moment of life that comes my way. In fact, this Christmas was in a cabin on Eagle River in Alaska, lit by candles and heated by kerosine, drinking, playing card games, and eating with friends of friends. In the sunset, a snow covered mountain was quite pink. It got dark early, but the stars were out.
Magical day, will never forget it. When my 92 comes, I will be ready.
Hope everyone had a great holiday!
Regards,
Cooter
In the US, health insurance started during WW2. Wages were frozen so health insurance was offered as a non-wage incentive to retain workers. Employer-paid health insurance was not taxed as "income". FYI.
No -- it is health insurance. The premium goes up (a lot) as one gets older. It's on the order of $1,500 a month for an ordinary plan for a insurable non-group plan individual now. Who can pay that? Not any burger flippers that I've ever met. Usually car insurance (non-liability) goes down as the car gets older, of course.
Bruce, you're right about all this, except here:
"America can pay for Edna today." It's only true insofar as the Fed can keep printing credit and the Treasury can keep selling debt--which is the same as saying "America can't pay for Edna, not even today."
All we can do is borrow money to pay Edna's Medicare bills, which is not the same as paying the bill. When you pay a bill, the debt is extinguished. What we're doing is financializing an enormous joint medical care mortgage with a terminal-sized balloon payment due in a few years.
My best guess is that the bullet will come due about the time we reach the end of our ability to print and borrow.
80% of someone's lifetime medical costs are in their last 3 months of life.
Doesn't really make sense as a use of resources.
And we need to do it better... And the street option? No.
But the Marxist ideologies that have been adopted by the left as a whole have not helped with their deliberate destruction of family and church... And therefore community.
Its all detailed
1. Constant change to promote confusion.
2. Massive immigration to dilute community
3. Unpredictable justice system that protects the perpetrator.
Etc etc
http://www.discoverthenetworks.org/viewSubCategory.asp?id=552
Have you ever questioned why it's 80% and not a half of that? Are you curious to know what pricing he put into place for drugs?
Wiki : Medicare Part D
Former Congressman Billy Tauzin, R-La., who steered the bill through the House, retired soon after and took a $2 million a year job as president of Pharmaceutical Research and Manufacturers of America (PhRMA), the main industry lobbying group. Medicare boss Thomas Scully, who threatened to fire Medicare Chief Actuary Richard Foster if he reported how much the bill would actually cost, was negotiating for a new job as a pharmaceutical lobbyist as the bill was working through Congress.[28][29] A total of 14 congressional aides quit their jobs to work for the drug and medical lobbies immediately after the bill's passage.
If we want to be thought of as a civilized society then we must take care of each other to the best of our abilities.
This is a moral issue and it'll be interesting to see all the Sociopaths come out and comment on this. However, this is an easy question to answer right here and now. 10-20 from now not so easy.
So yes we should abide by Edna's wishes otherwise we end up being Spartans. There are not many of us who would last long in a Spartan culture what with all the kicking into pits and forced marches. My hemmaroids are flaring up just thinking about it.
What is the level of "the best of our abilities", and who decides that?
You can't ask that question. Because if you do, the person posing as noble by putting forth that standard will then have a great risk of looking like either a fool or cruel. The point of making such a statement is to seem noble. By asking such questions as you do you're ruining it.
So . . everyone has an obligation to Edna but . . Edna doesn't have any obligations to anyone else? Do they get abolished when they give you your AARP card or something? A modest, sensible person living her 10th decade on this planet might hesitate to incur massive costs on others to get her preferences. But this is America in the 2010's. Causality's a four letter word.
OK Fred, if your assumptions of affluence in your old age just happened to be wrong, then we can assume you will committ hari kari for the sake of the greater good, correct?
Fred. Fuck You. I'll bet you have no problem dropping a trillion dollars on a new weapons system, and I'll bet you would kill hundreds of innocents if you believed that doing so would save your own life. Merry Christmas.
You don't know me. You're laughably, 180 degrees wrong about my attitude toward the defense budget. You swear at me and make a claim of obscene lack of perspective on my part. In the process your statement indicates perhaps a warping of perspective due to a much too great belief in your powers of inference. Happy new year.
I don't know you, but I read what you had to say. Why all the concern about your brother and no concern about Edna? And don't tell me it's the age difference. I've known several 80+ year olds full of life and vigor. P.S. Do you support the "war on terror?"
Come on. Do you really think anyone posting as 'Fred Hayek' is likely to be a fan of the grotesque, unconstitutional sham that we call the 'war on terror'?
I have no clue what "Fred Hayek" means. Please enlighten me. What about my other question?
Fred would be a shortened, anglicized version of Friedrich as in Friedrich Hayek.
As to your other question, I wrote a few hundred words answering it but decided in the end not to bother. Of course there's a natural inclination to feel that resources are better put toward the health of a 51 year old than a 94 year old.
Ah yes. Ayn Rand's friend. Fuck the old and the weak, eh Fred/Ayn? I say again. Fuck you.
With all due respect, you don't know what you're talking about. You don't seem to know anything about Hayek. Please read up. They were not friends. I could go on but why. You have to choose to learn.
List three signficiant differences between Rand and Hayek.
I'm not here to work for you. Read up. Hayek was less of a proponent of laissez faire than Rand was. You don't seem to understand Rand either. Not wanting the state to do something does not mean you don't want it done.
Given your proposition that Rand does not equal Hayek, it should be no work at all to list three significant differences. But that's okay. I understand that "I'm not here to work for you" = "I can't do that." Nice work.
We'll see how brave you are when you're staring death in the face.
My brother had a stroke and died this year. He had a huge loss of mental faculties. We could have chosen to have him go on but my brother was gone at that point. We all got to watch my brother die over the course of about 8 days. It was a little rehearsal for making terrible, tough decisions.
And, Edna was not staring death in the face. She was staring significant inconvenience in the face. And she's ninety freaking four, not thirty four. Ninety four.
No one posting here collects Medicaid for a member of their family.
No one posting here has parents whose combined age is 204.
No one voting on Medicaid knows anyone on Medicaid.
We're gonna live forever with good health and our mental faculties in place.
Availability of medication (and I do not mean price) will not be an issue.
No one here has lived through too many inflationary cycles so they are unable to meet their bills anymore.
We're gonna be able to keep up with technology when we're 85. We'll be able to play our television set. Our Android will be a piece of cake. Paying bills online, no problem.
Le Carre who typed all of his past novels on yellow legal size paper had it down cold. It's about sins of omission, Smiley remarked to Peter.
The first time you do the paperwork you understand the phrase "sins of omission."
We have turned it all into a Moebius strip, and you don't turn corners on a Moebius strip.----e2thex.
Sparta was the Last Civilized society on Earth it all went to hell afterwards
Too bad they didn't pay as much attention to mental capabilities as to physical otherwise we'd all be Spartans today
Nah fuck that. Whats more important, money or life? Money is just shitbag ideas, not even useful as toilet paper.
If you were to say there was a shortage of doctors, and we had to allocate the resources wisely I could understand that. Or if there was a shortage of medicine. But to say people have to die because of a shortage of money, which only has imaginary value. That is how fucked up the world has become.
Yes, all that civilized rape of young boys. Truly legendary.
You have a point there but those quirks could be worked out over the long term.
What Spartans had that today's society does not is a rational view of the world(except for believing in gods etc.) but that's another quirk to work out
They knew only strong survive, they where a Darwinistic society 2000 years before Darwin! I'd do pretty much anything to travel in time and be a Spartan oh well.
But than Christianity came along anf F*Cked Up the World! With the message of equality and universal love(even for enemies) Tainted the Human Spirit till today and with no end in sight. It all started there with Jesus *Fuking* Christ, regardless if he really existed or was just a myth the Religion that bares his name Corrupted the Soul of Mankind, pagans knew how to live in peace with nature and their inner selves they only fought wars that where economically justified and not a senseless slaughter for no reason(ok ok more or less). But than came Christ along and told everybody to put their lives on their heads from now on black was white, up was down and good was bad. What followed where the infamous Dark Ages till man rebelled against religion 1500 years later, however the Spirit remained tainted even after dropping the physical bondages of religion mankind still has it's Soul corrupted by it and it will take another 2000 years to fully get rid of this Cancer, we would have none of those discussions and very few of the problems we have today where it not for a '1 god religion' taking over the world
Not too well acquainted with pre-Christian history, are we? Pantheism has always been the basis for a paradise on earth. Just check out India, for example. Suttee. untouchables, one-third of the world's poor, countless millions sleeping on the streets and living in unspeakably filthy conditions, etc., etc.
And it's too bad the European white man came over to the new world and took a dump on all the peace and good will between the Native Americans. The Pawnee did manage to completely eradicate the Arikara and several other tribes before those damned monotheists showed up.
I got a feeling the Spartans would have made short work of you.