I recently commented on Facebook that in 20 years I will be in my late 50s, caring for my elderly baby boomer parents, and trying to pay for the young adult aspirations of three children, who will hopefully aspire to college. I half joke about that future time now, but my hunch is that then I will be very tired and very poor. In response to my Facebook comment, my brother replied, "I've printed out these comments so that in 20 years I can say, 'See Amy, you said right here on FB that you would be taking care of Mom and Dad.' Facebook: solving uncomfortable family conversations since 2007."
Although I don't think they would agree that Facebook can take the place of intentional advanced care planning, I do think bioethics visionaries and heroes, Daniel Callahan and Sherwin B. Nuland, would agree that old forms of health care are dying and new forms are coming to life. In a recent article in the The New Republic, they announce the death of modern healthcare in "The Quagmire: How American Medicine Is Destroying Itself." They begin by touching on the fear that many of us Gen Xers are starting to glimpse -- the oncoming tidal wave of baby boomers into old age and, in theory, Medicare: "[Twenty] years from now, the maturation of the Baby Boom generation will be at flood tide. We will have gone from 40 million Americans over the age of 65 in 2009 to 70 million in 2030... The chronic illness of the elderly will be frontline."
Wow. How will we care for all these people practically, compassionately, emotionally, spiritually and financially?!
Callahan and Nuland answer that question by saying that neither the elderly nor their caregivers can or will survive or thrive by following the current philosophy of health care in this country, which focuses far more on cure than on care. They ask, "Can we imagine a system that is less ambitious but also more humane -- that better handles the inevitable downward spiral of old age and helps us through a somewhat more limited life span as workers, citizens, and parents?"
They answer yes, and they call for radical reform. They paint a vision of a top-down, bottom-up study of the entire U.S. health system, a multi-year, multi-disciplinary project whose aim would be to change the very culture of American medicine, which will require a "conversion experience on the part of physicians, researchers, industry, and our nation as a whole."
My first response to their rallying cry was to roll my eyes. Why? Because they are both in their 80s (they admit their ages in the article), and when I am in my 80s I, too, will call for total overhaul and upheaval of every system I can think of, both because I will have the wisdom to know that radical revolution is often what is needed in systems, and because at 80 I know that am not going to be on the frontline of a revolution doing the heavy lifting of transformation.
My second response entailed realizing that unless other Gen Xers like me commit to being a part of a transformative solution, we will be paying the price in our old age. On one level, this is selfish, but at a deeper level, it's an honest attempt to treat others as we would want to be treated ourselves.
So, to whomever out there has power in government, health care and philanthropy, as a Gen Xer, a pastor, a writer and a future caregiver who will pay the price, literally and figuratively, for the future of health care, count me in. Like most of us, the health care system is filled with names and faces of people I love, and because of them, I care about our health care system. I hope that through caring that leads to intentional attention, sacrifice and innovation, we will move toward curing it. I close with Callahan and Nuland's inspiring words: "We can do this thing again. It will take political will; unyielding leadership; vast amounts of money, both from government and private philanthropy; and extreme patience. Above all, it will take the confidence of the American people that a more humane, more affordable kind of medicine is possible."
Who's with me?
To read more about aging, death and dying from Amy Ziettlow, visit www.familyscholars.org.