News that Vermont's Senate recently passed a single-payer health care system must have gladdened many progressive hearts, but truth be told, future health care costs would bankrupt America even if single-payer systems spread nationwide.
That's because the problem's not in the accounts receivable department; it's the actual cost of health care, now growing at roughly seven percent a year. That's about twice as fast as the economy grows in an average year.
And since the future of Medicare is one of the things forced onto the table by Republicans as part of a deal to raise the debt ceiling, minimizing that rate of growth could mean the difference for many aging Americans between some health care, and, under the Ryan Plan, de facto health care rationing according to the ability to pay.
Meanwhile, saying you've solved America's health care crisis by changing how you pay for it is like saying you've stopped the spread of nuclear weapons by outlawing the nicknames of certain missiles. And because the country is getting older and sicker, focusing on how to pay, instead of what you pay, does almost nothing to bend the cost curve.
The Alzheimer's Association, for instance, says the cost of treating that disease will grow from $189 billion in 2015, to over $1 trillion in 2050. That's twice what we spend for Medicare today. And the National Cancer Institute expects annual cancer treatment costs will grow 27 percent by 2020, to $158 billion.
Can we do anything about this? Maybe, if we come to grips with the fact that there are worse things in life than death, that modern medicine offers many of them, and that with today's medical technology, a worst-case scenario isn't dying -- it's years of falling apart, slowly, ending with a few years of progressively aggressive treatment that basically keeps you, well, not dead.
This nightmare has been given to us by what Daniel Callahan and Sherwin B. Nuland, in a May 9th article in The New Republic titled "The Quagmire", call The War on Death. The article isn't available free online.
What we've bought into, say the authors, is the idea that we're all somehow going to live a long and healthy life, followed by a brief decline and a quick, easy death -- hopefully, while we're sleeping. A pretty picture; and pretty unrealistic.
"What we need is a different philosophy about death and dying," says Callahan, who's president emeritus of The Hastings Center.
The good news in that grim analysis is that it finesses the toughest political problem about medical care in America -- the screaming on the Right about so-called socialized medicine and death panels.
This is because what we're talking about here is mostly a matter of personal choice, and professional guidelines, not government programs. No faceless government bureaucrats play any part in this -- although personally, I've never seen any difference between faceless government bureaucrats making health care decisions, and faceless private health insurance bureaucrats making the same decisions.
This doesn't mean making choices like that is easy. It's not, not by a long chalk. Most people don't want to talk about dying. And that goes double for families with elderly parents, who will otherwise wind up managing their parent's care in those last, machine-filled days in the ICU.
But if we can bring ourselves, as individuals, to move past the fantasy of a good, long life and a good, short death as some sort of real probability; come to grips with the fact that, as medicine is practiced now, it's likely to put us on a road to the reverse; and organize our personal health care around avoiding that worst-case scenario; we can not only avoid that horror in the ICU -- we can maximize the likelihood that we, as a people, can enjoy decent healthcare for all, however we pay for it.
There are some other things we can do as well. For one, as Callahan and Nuland say, we can do something about the very high costs of medical school. As they point out, those costs force young doctors into the big-money medical specialties that let them repay their debts, but starve America for the primary care physicians we need to manage our health.
Another: we can stop buying the latest drug as if it was a flashy new toy, and rely on tried and true medicines that do pretty much the same job for fractions of what the new drugs cost. This is a different version of what Callahan means when he talks about needing a different philosophy about death and dying; these new drugs are inevitably sold as great advances in medicine, offering almost unlimited health, while never mentioning the cost.
A senior FDA scientist, speaking on condition of anonymity because he isn't authorized to speak to the press, told me that not only are the potential side-effects of most new drugs often poorly understood; but that they produce only very marginal improvements in results in return for vastly higher costs.
Securities research for pharmaceutical companies, for instance, routinely touts the financial value of such drugs not only because they produce higher profits today, but -- because they often have to be taken more or less permanently -- produce reliable, long-term revenue streams. This is great for pharmaceutical companies; but for Americans paying taxes and insurance premiums, not so much.
A third thing we can do: think about what we're giving our elderly relatives when we start fighting to keep them alive -- an all-too-common scenario-- and show some courage and compassion.
Let me tell you a little story. My best and oldest friend -- we were like brothers for 50 years -- died about three years ago from cancer-related complications. His wife was his health care proxy, and I was his back-up proxy. He had no hope of any recovery, his condition wasn't reversible, and he made us promise that whatever happened, he wouldn't end up on a respirator.
He did though, for reasons that don't matter now. It's enough to say he still didn't want to be on it, knew he was dying that day, and wanted to go. All his wife had to do was give the order to disconnect him; the medical staff was standing by.
But she couldn't pull the trigger. She's in no way a bad person; it just wasn't in her. I had to do it, and was proud to give my friend what he wanted. After all, he would have done it for me.
Of course, if I hadn't been there, the hospital would have had to do everything in their power to keep him from dying as long as possible, running up millions of dollars in bills that, one way or another, would have paid for by you and me. For no result.
I'm sure there are other things we can do to control costs instead of just deal with the payments piece. These are just three of them. But it seems to me that if we can screw up our courage, face the facts and choose wisely, we can have a batter life and a better death, and the American people can have better health care in the bargain.
That seems to me to be a goal worth pursuing.
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