Decades ago a doctor would examine their patient, make a diagnosis and assign a treatment. Sometimes it even worked. Then along came CAT scans and exotic laboratory diagnostic tests. After that more expensive tests, MRIs and PETs. Each new test cost more, much more, than the previous.
Yet, in many cases, these expensive tests haven't really helped at increasing life expectancy. Approximately 30 percent of men over 50 and 50 percent of men between 70 and 80 have prostate cancer. However, according to the U.S. Preventative Services Task Force, the lifetime risk of dying of prostate cancer is only 2.8 percent. And with all the false positives and false negatives of the Prostate Specific Antigen (PSA) test, the National Cancer Institute reports that many doctors are no longer recommending it, yet Medicare still covers annual PSA tests for men 50 and over.
Similarly, recent research published by the New England Journal of Medicine looking back at over 30 years of U.S. health statistics shows that women who had mammograms were just as likely to die from breast cancer as women who did not have mammograms.
So, while we're not getting any healthier or healing any faster, medical costs are going up and up. In fact they are going up at a rate so much steeper than other costs and inflation, that it will shortly break the bank. At the rate health care costs are going up, our social security system is projected to become insolvent shortly.
On May 30, 2013 the administration reported that "Medicare's hospital insurance trust fund will be exhausted in 2026 and the Social Security trust fund will be depleted in 2033."
On June 1, the New York Times headline article was the U.S.'s $2.7 trillion medical bill, which is blamed on expensive drugs and heroic care at the end of life. "Heroic" really means "ridiculously expensive."
By some accounting, end-of life care is equal to one-half of a person's lifetime medical expenses. The 6 percent of Medicare patients who die each year account for 30 percent of medical expenditures.
We're going to bankrupt ourselves by spending more and more money for an elusive dream, but it is a dream the majority do not even share.
In a recent survey, 30,000 people were asked the question, "With advances in medical science, how long do you want to live? 80, 120, 150 or forever." About 60 percent of 30,000 said 80 -- the current life expectancy. Overwhelmingly, the reason given was that people didn't want to be old and infirm any longer than they had to be, even if a pill allowed them to delay this inevitability.
I am definitely one of those 60 percent. In the olden days, when we lost functionality and the ability to contribute, we died in our bed or we would be taken out by a lion or we left the village discreetly at night and walked off towards the ice pack. Now we are kept from dying by respirators, expensive drugs and 24/7 medical professionals with the costs eating up the capital that our next generation could be enjoying for living.
Maybe there is little chance that we can change the nation's crazy health care system, but I can change my health care system.
I am going to take a pledge that if I hit 80 I will still be grateful for a Heimlich maneuver if I'm choking at a restaurant, still see my doctor and maybe take the medicines they prescribe, but I am not going onto a respirator. I am not getting a transplant. I am not having surgery. I am not going to spend my days and nights in a hospital bed hooked up to machines waiting to die. I am not going to piss away our nation's treasury and have money spent on me to prolong the inevitable.
One great grandfather of mine lived to 96 under his own care. I don't mind if I follow him by living my life to its fullest and being able to be ambulatory and sing and dance and not rely on family and medical professionals to provide daily care into my 90s. When I go, I hope I die well: suddenly, in my sleep or at home or in hospice surrounded by loved ones.
The problem with this declaration is that once you enter the hospital system the machine absorbs you and it is very difficult to assert your living will wishes. Most studies show that doctors and hospitals are generally unaware of and/or completely disregard a patient's living will.
So as part of taking this pledge, on my 80th birthday I am going to put on a metal wrist band etched with the following words, "Medical Alert -- Do not intubate, ventilate or resuscitate," with a website linked to copies of my living will. Don't waste money on me to keep me alive past my due date. Don't get me wrong. I don't plan on shooting myself when I am 80. I'm happy to stay alive as long as I am in good working order: minimal aches and pains, ambulatory and mind still working well. If you want to take the pledge, too, send me an email.
The marked increase in life expectancy over the last century has mostly been due to better nutrition and sanitation. Medicine too has played an important part, and I am very grateful to our health care practitioners on their focus on fighting to save lives. I am glad they were there for me in my formative years when I had my whole future to look forward to. I am glad they were there for my children and for the other children. I am glad they are there to provide disaster relief. But, please, please, when I am inevitably sliding out of this plane to the next, DO NOT waste our precious resources on keeping me alive. I want to stop living when I stop living.