Saturday, August 01, 2009

The American Way of Life (and Death)

This week's entry on The "Impossible" Healthcare Solution: Go Back to Cash raises issues not just of healthcare per se but the value systems we live and die by.

In Survival+ I set the goal of reaching an integrated understanding. The topic of healthcare, recently explored here in The "Impossible" Healthcare Solution: Go Back to Cash and More on The "Impossible" Healthcare Solution (July 31, 2009), cannot be comprehended in isolation; our understanding of health and thus of healthcare must be integrated with an understanding of healthy food, healthy eating, healthy lifestyles and then, as life comes to a natural end, a natural acceptance of death.

Correspondent Michael Goodfellow, whose summary of the Obama healthcare plan was included in the July 31 entry, made this observation after reading all 11 reader comments:

I'd really like to hear more from doctors. To me, they are the only group in this discussion who could have made an intelligent tradeoff between cost and quality. I still prefer market solutions, but if you are going to listen to experts, at least some of them should be doctors.

Excellent point--and thus I welcome these additional comments from Doctor "Ishabaka" (his pen name) who has experience not just in the U.S. but Canada, Britain and Japan--all nations with centralized, government-operated healthcare:

"Ishabaka" M.D.

I read with interest your readers comments on a cash based medical system. The one that interested me the most was the comparison to auto insurance - but - we already have catastrophic health insurance (that's all my family can afford, and we have a $10,000 deductible). This puts all those greedy hands back into the healthcare systems - health insurance company execs who consider ten million dollars a year a standard salary, etc.

Once again, I want to emphasize that we could save a ton of money if people took care of their own, their families and their community's needs themselves. Three examples come to mind:

1. - the most egregious - a woman with an infant on Medicaid brought her child to my E.R. with a high fever. The nurse asked her if she had given the child any Tylenol. The mother's response was "No, that's YOUR job".

2. - "granny dumping" - many elderly folks living with their family suddenly develop mysterious unexplained "symptoms" around Christmas. This is because the family thinks they'd have a better holiday without granny around, and would like her admitted to the hospital "for observation".

3. - a positive one. I mentioned how difficult it was to deal with training in the Neonatal Intensive Care unit - but one thing I found was quite touching. For various reasons, premature babies often need blood transfusions. For every baby in our NICU we had the name of a person to call. Just so you know, fresh blood is far superior to banked blood. Many valuable components - most importantly the clotting factors (chemicals that make the blood clot), degrade within hours of the blood being refrigerated. The folks with their names on the list were each attached to one baby. They were blood donors who had that baby's exact blood type. Many had no relation to the baby they were assigned. They would come in, any time, night or day, and donate blood when "their" baby needed, for no compensation - and the baby got completely fresh blood.

Finally, I found it interesting that one reader thought a doc would be shocked to be paid with chickens in a Depression. I would GLADLY work for chickens, or home-grown organic vegetables any day. Maybe I should have a sign on my desk "Will Work For Food" : )

The key point made by Dr. "Ishabaka" is that many Americans have abdicated responsibility for their own health. It's up to "Big Daddy Government" to take care of us, fix us, take care of our families, and do so for "free" in the sense that we should pay nothing but taxes--and conveniently, about 40% of the nation's households pay no Federal income tax at all, just the 7.5% FICA (Social Security) tax if they have a formal job with tax withholding.

Does anyone seriously think a system which collects a few paltry dollars from its enrollees each month (Medicare) and another vast system which collects nothing from its enrollees (Medicaid) can be supported by a nation in which most of the taxes are paid by a dwindling middle class caught between the "lower 40" who pay nothing and the "upper 1%" who escape much of the tax burden with accounting strategies and tax loopholes made into law by craven toadies in Congress in exchange for large contributions to their campaigns?

If you arrange a family trust ($10,000 to $20,000 in legal fees), when the trust kicks in all the family assets are re-set from their original "cost basis" to "current market value". That means assets which were purchased for $1 million and are now worth $10 million are transferred with no taxes owed on the $9 million in capital gains.

Try selling $10 million in assets which were purchased for $1 million and check out the resulting tax bill. Even with long-term capital gains that works out to $1.35 million. If you live in a state with income tax, add another hefty sum to that bill.

These are just two of the many ways the Elites have at their disposal to reduce their taxable income, leaving the productive middle class to pay more than an equitable share of taxes. You would have to have access to high-powered tax attorneys to get a briefing on the full spectrum of tax avoidance strategies available to the super-wealthy.

But the political class doesn't want to anger the middle class with these inequalities, so it has chosen (with the citizenry's passive approval) to make up the difference between what we spend and what we collect in tax revenues by borrowing trillions of dollars from overseas investors like the Chinese.

But as this Wall Street Journal story submitted by Charleston Voice outlines, the evidence is piling up that the Chinese are no longer buyers of any Treasury debt with maturities longer than a year or so: Bond Worry: Will China Keep Buying?

So what will a people who have largely abdicated responsibility for their own health (and thus healthcare) do when our creditors stop loaning us $1 or $2 trillion a year to fund our "rights" to healthcare?

One of the most egregious sticking points in the current "sick-care" system is the heavy skewing of costly care to the final days, weeks and months of life.Does spending hundreds of thousands of dollars on procedures and tests really improve the last days of a citizen's life? Or does all that churn end up further burdening the person and their family? If so, it is not just a waste but an unconscionable waste.

This is not a question we can ask, because the U.S. legal system (what I have characterized as a state of mental illness) and various medical protocols require caregivers to take any and all extraordinary measures lest they be accused of malpractice--with the sole caveat that some modest limitations may be put in place if the patient signs certain documents and chooses hospice.

Thus it was very profound to read the following account of a different way of passing. Here is correspondent Chris H.'s account of his Mother's passing.

Chris H.

Accurate point regarding end of life expenses. My mother died a bit over a year ago. She was diagnosed with advanced, terminal pancreatic cancer and she declined chemotherapy, opting instead for palliative care. This was her choice, to die at home. Her three children, me, my brother and sister, all in our 50's and with 4 kids between all of us, accepted her decision and began planning with each other how to care for her.

This was no easy feat. Mom lived in the far northern region of Appalachia, in a small rural home by herself. My sister lives in Colorado, I live in Washington State and my brother in downeast Maine. My Aunt, in frail health herself, also was present, driving 6 hours north to be w/her sister.

Mom had a Dr. that would visit her and prescribe Fentanyl, a powerful narcotic pain-killer. We put the medicine patches on her ourselves. We put a hospital bed in the living room and took shifts, sleeping on couches, the floor, etc. We got some hospice care for awhile but determined we did a better job ourselves.

When she died, we were all there, my sister and Aunt washed her body, dressed it in clean things, sprinkled flowers on her and put on peaceful music. We waited several hours before calling the funeral service to take the body for cremation. My brother and I carried her body out the front door. A few days later we picked up the ashes for later burial.

The entire cost was a couple thousand dollars, including Dr. home visits and funeral expenses.

Here is a picture of her "in state" and a poem I wrote:

For CB and Her Hills

Your hills, as familiar as beachwaves of youth
but instead of sentient mayapple and corn,
Memory and meaning grown tangled as roots of scotch pine
mingled fall hay-sharp in sleeping.

Your hills, stoic and mute
toward the silence of your fears
Waiting out your nights,
incubating your dreams.

Your hills and I too, have trod the carbons
that constitute their heart,
heard also sodden thunder, their voice...
Seen cumulus in the pond below blue spruce.

How we rolled down those hills
and gathered things!
Together we sought words' fountain source,
Like deer-known springs whose taste is wine.

There amongst the hills of spring
We separate our minds -- where I hear alone,
Some bird call, some memory, what complex song?
A promise of shad-blossoms in a camouflage of thorns.

Chris H. April 2008

Thank you, Chris, for a beautiful account of a respectful, caring death without "heroic measures" except by family members seeking to offer a passing with dignity to your Mom.

Chris sent a very touching photo of his mother "in state" which I considered reprinting, but I decided not to--with so many Americans apparently out of touch with death and dying, an image of a person who has passed away peacefully might be upsetting or disturbing to some percentage of this site's readership.

This is itself a sad statement, for death is as natural as life. In shunning death and distancing ourselves from the natural passage from this life, we are also shunning life itself in a profound way.

Thank you, Doctor "Ishabaka" and Chris, for your valuable narratives.

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