Should there be an expiration date to health care access?

8 05 2009

Access is one of the biggest buzz words in health care…and it’s a primary driver in the reform efforts underway in DC, right now. But is that access open-ended or, in a time when science has replaced nature and dollars are few, is it worth asking whether there should be an expiration date to access…or at least some controls?

Ellen Goodman raises this question to some extent in an op-ed in today’s Boston Globe. She starts with a recounting of the Obama family’s struggle with the issue of whether to provide life-extending–but not necessarily enhancing–treatment to his dying grandmother. They opted not to. The President told the story not so we could be voyeurs to the painful decision he and his sister wrestled with. He raised it to shine on a light on what he called a difficult moral issue related to sustainable health care.

I’m glad he did…it’s a question that should be front and center in American discourse today. The bottom line is that this country too frequently keeps people alive not because they should–but because we can. Rather than compassion for the individual, it’s an act of ego in the case of the medical providers (look, ma, I’m God!) and selfishness on the part of the loved ones (we may not want to deal with you as we tuck you away in a nursing home or in front of a tv, but we sure as hell aren’t going to let you go).

And it’s an act that raises not only ethical issues and quality of life issues, but increasingly financial ones.

As the Baby Boomers age, do you really think we can pay to extend their lives as long as science allows? Forget the cost to their individual quality of lives. What do you think the cost will be to everyone else? To the adults whose taxes pay for that care? To the kids who, most likely, will be denied access to keep seniors here for just a little bit longer? At a time when the Dems are adding to the federal budget at a rate of $100 million PER MONTH to right our domestic ship (following eight years of Republicans spending untold millions per month to sink our international one), how much longer do you think we can keep printing play money to pay for all this?

Now, rest assured Mom that I’m not implying in these questions that we should gather all the old folks at age certain and bid them a fond adieu. Life’s real questions don’t have easy, absolute answers.

But that doesn’t mean we should avoid the questions.

It does mean, however, that we won’t find the answers through political posturing (which means Members of Congress and the media can’t participate).

Answers won’t come from the scientific community, either. As I’ve watched what’s happened with AIDS in the past few years, it’s been horrifying to see what a disease that once was fueled by anger and passion now fueled by cold-hard-cash and career advancement/security. So, let’s leave the scientists (and docs) out of this conversation, too. It’s in their interest to keep folks alive as long as possible.

But, let’s do have this conversation among ourselves. Around dinner tables. On front porches. Even on the phone if distance makes face:face dialogue impossible.

Let’s ask “to what end” (thank you GES) we are overruling nature and keeping people alive just because we can. Is it for them…or for us? “To what end” is the cost–financially, but also to the cycle of life. Are we standing in the way of Life by blocking Death (because we so fear Death)? And what kind of life does that give us, anyway?

No easy answers, but–as one of Rilke says–maybe we can begin to “love the questions”…and each other, not for science’s sake, but humanity’s.




2 responses

9 05 2009

Sometimes I think we treat our pets more humanely the we treat people at the end of life.

11 05 2009

That’s because pets offer unconditional love. It’s a bit more complicated with humans.

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