Jane Gross paints a bleak picture of reality:
No one then envisioned the stunning advances in medicine that now keep people alive into advanced old age, often with unintended and unwelcome consequences. Indeed, scientific reports have showed the dangers, not merely the pointlessness and expense, of much of the care Medicare is providing.
Of course, some may actually want everything medical science has to offer. But overwhelmingly, I’ve concluded in a decade of studying America’s elderly, it is fee-for-service doctors and Big Pharma who stand to gain the most, and adult children, with too much emotion and too little information, driving those decisions.
In the last year alone, and this list is far from complete, here is what researchers have found both useless and harmful, according to leading medical journals:
- Feeding tubes, which can cause infections, nausea and vomiting, rarely prolong life. People with dementia often react with agitation, including pulling out the tubes, and then are either sedated or restrained.
- Abdominal and gall bladder surgery and joint replacements, for those who rank poorly on a scale that measures frailty, lead to complications, repeat hospital stays and placement in nursing homes.
- Tight glycemic control for Type 2 diabetes, present in 1 of 4 people over 65, often requires 8 to 10 years before it helps prevent blindness, kidney disease or amputations. Without enough time to reap the benefits, the elderly endure needless dietary limits and needle sticks.
Yet Medicare, which pays for all of the above, does not, except in rare instances, pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet. . .
Why is nobody enraged that our taxes are paying for hip replacements, for example, for people with advanced Alzheimer’s disease, who are incapable of physical therapy? Why is nobody saying out loud, like it or not, that one of our great challenges is figuring out what to do about our elderly people, our fastest growing-population cohort, which will grow exponentially when 76 million baby boomers join the ranks?
The current system is unsustainable, but the alternative is the third rail of health care policy. President Obama’s original legislation included Medicare reimbursement to doctors for discussion of end-of-life issues. These are what Sarah Palin called “death panels”; days later, they were cut from the legislation. An Independent Payment Advisory Board will make recommendations to Medicare about what works and what doesn’t, beginning in 2015, but its proposals are not binding, as intended. A long-term-care insurance provision — with an average daily benefit of a mere $50 — is under siege.
It is not just that the health care system is broken – it is, critically – but the way we think about health is broken. Gross’ argument is a big step towards addressing that broken thought process. Our words have lost much of their meaning from a century ago. Happiness is a great example. “I am happy” is a phrase we utter when eating ice cream or watching a good film. That’s not what “happiness” meant when it was written down by the Founding Fathers. “Happiness” in that sense is one of flourishing, that one’s entire life is going in the right general direction, as are the lives of those close to you. Happiness is measured in a moment of reflection and thought, not based on an in-the-moment gut check.
Health also has been so tainted. Health, as we use it, is a broken synonym for well-being. But something is lost. “Health” as we use it is not about the person but the body. There is a great doctor colloquialism that goes, “treat the patient, not the disease.” Such an adage has never been so relevant to our current crisis. Cutting edge technology that can be life-saving is only of value when the person receiving the treatments can recover. Again, I emphasize that my argument is not that the treatments are only worthwhile if the body will repair itself completely, but that they are only worthwhile if the person can recover.
We can now keep a body alive well after the person inside of it has wilted away to nothingness. Life is priceless, yes, but so is dignity. Our idea of health needs to move beyond the body to a place where a person can, in their last moments, lucidly say, “I’ve had a good life. I’m happy. Goodbye.”