Tough Conversations

Saturday, August 1, 2009
As the debate heats up about the Health Care bill, the blowhards are hard at work, escalating the conversation. On the one hand, you've got Pelosi talking shit about how the insurance companies are members of the Axis of Evil (an opinion to which I'm not unsympathetic, but then I'm not the Speaker of the House), on the other you have Fox News screeching about how Obama-care will kill your Grandmother. On purpose.

What's being lost among all the caterwauling is an incredible opportunity to have a tough conversation that needs to be had - the conversation about medical care at the beginning and end of life, and how much is "too much."

Medical ethicists have this conversation all the time, of course. They have to - decisions have to be made regarding the best course of treatment for individuals, and whether or not society is best served by a donated organ going to this recipient, or that one. Someone has to make these decisions, and it seems like Americans are squeamish about even having the conversation, let alone making the tough decisions that go along with them.

But we can't ignore this problem forever. Those over 85 are the fastest growing segment of our population, and the cost of their medical care is growing every year. Discussing their care, their quality of life, and yes, their end of life decisions, is something we need to address as a society.

And it really pisses me off that the politicos are using these issues to score partisan points off of each other, rather than leading their constituents to the table to discuss them in a mature and sensitive way. People want the ends of their lives to be dignified, meaningful, and to have a good death. That's not too much to ask, and I believe we have an obligation to our seniors to help them achieve those goals.

I don't claim to have all the answers. I've thought about some of the issues involved, of course - I have relatives who are at an age where the matter is anything but academic. I don't want my senior family members to suffer because medical technology is capable of extending the length of their lives without increasing the quality. Because in many cases, administering treatment just because you "can" doesn't mean you "should."

I believe that assisted suicide should be legal under certain circumstances. I know people, people I love, who disagree with me vehemently on this issue. And yet, in spite of our diametrically opposed viewpoints, we can discuss the issue with mutual respect and support, and understand each other's points of view. Because we recognize that such matters are some of the most important questions we'll ever address as human beings, and the issue should always be treated with the courtesy and respect it deserves, not used to further our own ends.

So how come I can successfully discuss this with people I know, yet my elected leaders can't discuss the issue without accusing each other of evil-doing and trying to kill each other's grandmothers?

Please don't answer that. I know the answer, and it makes me ill. Sometimes I want to smack those in the public eye in the face in with a shovel. Actually, that's true most of the time. Grow up, American politicians and talking heads. You're disrespecting those who are most deserving of our support, and it's shameful.

7 comments:

Nathan said...

I saw something today that got me riled up on this same subject and I'll probably post something about it tomorrow. One unfortunate problem is when the opposition blatantly chooses it's most gullible target and then lies through their teeth about the issues that will scare them the most.

Yup. That makes it hard to have this conversation.

John the Scientist said...

Look, you know how I make my living, and I do not believe that government or private payers should have to shell out $500,000 for treatments that on average extend a cancer patient's survival by 6 months.

If I were filthy rich, would I pay it? Sure. If I had $1 million? No. My kids and grandkids could better use the money. Sometimes, it sucks to be you, and other people should not be forced to pay to un-suck your life.

Why should you have to pay for something to keep me alive when I wouldn't?

Also, rich old geezers who think nothing of dropping $50 on a bottle of wine with dinner a couple times a month and then complain about minimal co-pays for medicine and doctor visits piss me the hell off.

No, when your spouse kicks the bucket, that SS money should not come to you - the mortality is baked into the system by the actuaries. If you wanted more benefits, you would have had to pay a lot more into it to support your parents, and I'd be paying even more than that to support your sorry ass now. It is not a pay-for-yourself system. Idiots.

ntsc said...

John, and what do you do about the woman who has never worked and when her spouse dies the SS stops?

The actuaries should be taking this in to account when calculating benefits, if they are not it is not my problem (although it is as a taxpayer). That benefit exists precisely to do what you see as wrong, to put more money into the pocket of the lessor earning spouse at the death of the higher earner. When first started often the wife had never worked outside the home. Without it my mother, who did work full time most of her life, would probably have not been able to keep her house and certainly would not have been able to put the two younger, myself included through college, my benefit of about $100/month paid most of my annual living expenses then. My father did not qualify for a pension because he died 2 months and 10 days too soon.

If my wife dies, I get no increase in SS payments, if I die my wife gets my pension benefit (one of them - the other I'm not drawing yet) and her SS goes up $600/month.

Yes SS has problems and the politicians won't admit it, but the benefit package is not unreasonable, you would leave people destitute.

As to the $500,000 to extend my life 6 months, out of my pocket no, out of my insurance companies pocket yes. I paid for that insurance and it has an max annual payout of far greater than that. And yes, while my medical insurance is through my former employer, I paid for it via profit the company made from my work versus my wages. Nobody receives anything from their company that the employees didn't pay for or the company goes under.

I don't have a problem with rewriting the basic insurance contract, but then my costs should go down. I also have no problem under the existing contract of if I forgo the treatment upon my death my widow gets some percentage of the estimated cost.

When I was a kid my parents worked for a printing plant that employed 1500 people. Health insurance was handled by one woman in the personnel dept. who looked at the paper work and receipts, calculated 80% and cut a check. If it was an on the job injury the check was for 100%, in about 4 hours a day. If she was on vacation, my mother who was head nurse, did it. If Kay had medical questions she would ask my mother.

And I have no problem dealing with a government bureaucracy for medical benefits, at worst they are in general indifferent (I've been in the Army), the insurance company bureaucracy I deal with is profit driven, and my quality of insurance had dropped and direct cost to me gone way up in the last 10 years or so. Note I am aware that SSI disability bureaucrats have the mind set of profit driven ones by refusing all initial claims, but that is politically driven by people who do not approve of SSI.

Encore Entertainment said...

Good rant. The piece is suicide is especially accurate.

Janiece Murphy said...

Welcome, Encore Entertainment.

Anne C. said...

What I hate about the current insurance set up is that I am losing my primary care physician, whom I love, in my recent job change. I used to have Aetna, now I have Kaiser. It's a real pain in the butt, since I've been going to him for six years and have never liked a doctor as well as I like him.
On the plus side, I get my favorite dentist back. Granted, he's more expensive than some other, but he is wonderful. I hated losing him previously due to insurance changes.

Steve Buchheit said...

ntsc, the problem with demanding the insurance company pay out that half million is that you didn't pay in the half million. The rest of the people in your group will end up making up the difference in their higher premiums. Or, if your care last longer than your insurance contract, you 1) might be dropped and 2) see a commiserate higher premium.

And I have to go in with those who support surviver spousal support. Right now my income supports both of us, my SS is based on my income. Why shouldn't it also support my spouse (at a lower level which chaps me a little) if I die first? She's doing her part to help me earn this much.