But the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate. Everyone sees it but no one wants to talk about it. At a more basic level, Americans are afraid not just of dying, but of talking and thinking about death. Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health-care system will remain unfixable.
It doesn't seem to me that the problem lately has been a fear of death in America. It's a lack of respect for life, which is apparently a problem for Mr. Thomas.
There is no way we can get control of costs, which have grown by nearly 50 percent in the past decade, without finding a way to stop overtreating patients. In his address to Congress, President Obama spoke airily about reducing inefficiency, but he slid past the hard choices that will have to be made to stop health care from devouring ever-larger slices of the economy and tax dollar. A significant portion of the savings will have to come from the money we spend on seniors at the end of life because, as Willie Sutton explained about why he robbed banks, that's where the money is.
"Overtreating patients." Is that what we're calling saving lives these days?
The desire to see a physician is often pronounced in assisted-living facilities. Old people, far from their families in our mobile, atomized society, depend on their doctors for care and reassurance. I noticed that in my mother's retirement home, the talk in the dining room was often about illness; people built their day around doctor's visits, partly, it seemed to me, to combat loneliness.
Let's ignore the fact that many of the elderly actually need to see doctor's far more than a young person because their health is failing. My grandmother died this past summer and she had to see the doctor many times a month because she had frequent bladder infections, which nearly claimed her life on a monthly basis for years before her actual death.
Check out the article if you can stomach it. It let's you know how little respect some people actually have for life.
Added: I just posted this and after talking with my husband one more thought popped into my head. The basic idea of cutting costs and not ordering unnecessary tests is one that could help fix part of the problem with our system. However Mr. Thomas sites his grandmother's choice not to undergo further procedures (and she was allowed to make that choice) and then tries to derive implications that could be used across the board to cut costs.
That's where we disagree.
If a person who is dying of cancer doesn't want to go through yet another round of chemo it's their choice. I have a problem when the choice becomes the insurance companies or the governments (as some now claim it will be) and is taken out of the individual's hands. That's why the second quote about making "hard choices" is so disturbing. Who will be making these hard choices? More then ever this causes me to wonder if our elderly will be pressured towards ending their own lives, a claim which I thought earlier was just a political scare tactic. It seems to be a real possibility if many people agree with Mr. Thomas' views.