Our growing ability to prolong life and our shrinking ability to pay for it

There have been scores of recent articles about Congresswoman-elect Kathy Hochul’s upset win in New York’s 26th Congressional District special election.  They all seem to share a thread of incredulity, followed either by chortling or spin depending on the source.  These stories also share the sense that her victory was truly an underdog performance destined to become legend.

According to The New York Times, “Two months ago, the Democrat … was considered an all-but-certain loser against the Republican.”  Imagine that Republican’s surprise at having to give the congratulatory call on election night.

The pundits are laying blame at the feet of Republican candidate Jane Corwin for backing Wisconsin Congressman Ryan’s proposal to reduce the federal deficit in part by changing Medicare to a voucher system.  The Times, again: “Ms. Hochul seized on the Republican’s embrace of the proposal … to overhaul Medicare, and she never let up.”  Both candidates’relative energy and focus are also being credited or blamed for the result, but all sides agree that the singular focus on Medicare carried the day.

This election result is being touted as a modern-day example of the “Third Rail” of entitlements – touch it and get burned.  A quick Google search turns up at least a few of Indiana’s own Representatives who may be eligible to have the same sort of uncomfortable questions about “abolishing Medicare” asked by future contenders.  I will leave them unnamed in service of civility, but I don’t doubt some home office staff for each is working on a damage-control plan.  They are unlikely to feel too comfortable, since NY-26 is a real ‘red’ district, unused to electing Democrats to Congress.

In broader terms, I think this election result highlights two opposing and mutually-exclusive feelings held by much of our society today.  The first is “You’d better not raise my taxes or I’ll fire you!”  Of course, the second is “You’d better not take away any of my benefits or I’ll fire you!”

Unfortunately logic, cold and ugly as it usually is, says that only one of these demands can be met at any one time. This leaves the politicians scrambling to explain to an angry and often irrational populace that hard choices must be made.  As someone watching from the inside as our medical system crumbles, I can say with great assurance that what we are presently doing cannot continue.  It is crystal clear that something, or many things, must change.  What will change is truly up to us but the fact that change is coming and must come is undeniable.

Only a great fool would expect our Chinese bankers to continue to extend ever-more-tenuous lines of credit so that we can live as we please and ignore economic realities.  Thankfully, not a one of us is a great fool.  This leaves me in a quandary to explain the gridlock Congress seems to love regarding the topic of healthcare reconstruction – reform seems too limited a word.

Simply combine our growing ability to improve and prolong life with our shrinking ability to pay for it and you have a recipe for widespread disappointment or worse. The only solution is one that we had best come to as quickly as possible.  We must decide whether we are going to have our cake or eat it, because we certainly can’t and never will be able to do both.

Eric Marcotte is a family physician who blogs at doctorfoodtruth.

Submit a guest post and be heard on social media’s leading physician voice.

Comments are moderated before they are published. Please read the comment policy.

  • http://crackerbelly.me Mark Shea

    10,000 people per day are celebrating their 65th birthday and this will happen every day for the next nineteen years. The health care system and specifically long term care is straining under the burden of the previous generation. Now comes the Baby Boomer generation, the behemoth.

    Unfortunately, I think the cake has already been eaten and now it’s time to pay the bill. Payment will not only be made in dollars but in suffering as well. This needs to be addressed NOW. There is no opportunity to kick this can down the road. The crisis is upon us.

    Good post, thanks.

  • Allen

    In far too many cases, we are prolonging not life but suffering and the universal, natural dying process. Americans–the public and physicians alike–need to acknowledge more candidly that there is a real difference between the two. We must all more readily embrace earlier comfort and palliative care through hospice so dying can once again be experienced with dignity and with less suffering. Secondarily, the disproportionate monetary expense of futiley extending suffering and dying will be eased. Our nation might avoid its looming bankruptcy.

  • Steffi

    I agree with Allen. Dying with dignity can be powerful and liberating for everyone involved. There are 2 absolutes in life death and taxes. It is time for people to embrace a natural death and in turn reduce at least one of the many expenditures that lead to increased taxes. Next up return to the early 1900′s processes for immigration such as sponsorship, employment, independence and a chance for citizenship. Today everyone wants what this country can offer without paying the price,

  • Jack

    People have a hard time letting go especially with someone else is paying the bills. Choices would be very different if they have consequences.

    I believe anyone over age of 50 MUST have an Advance Directive.

  • skatz

    It’s easy for many of the readers of this forum to allow others to die to save money. The doctors who frequently post here are secure in the knowledge that they won’t need to make this choice for their loved ones or themselves. They have not only the resources, but access to whatever they want whenever they want. How simple to tell the baby boomers – just die already – it’s your duty to do so.

    Just curious – what’s the cut off in terms of illness and/or age? No cancer treatment at all – or cancer treatment of X amount for Y time? Or, do we do a means test – determine who and how much an an individual benefits society. Singles/no grandchildren – not so valuable – considerably less benefit. Post-menopausal women – valued less than men of a similar age who still have viable sperm?

    Why stop at healthcare – the baby boomers are also taking up much-needed jobs that the up and coming generation can do for less money. They’re living in houses and apartments that the next generation requires. They’re eating food (sometimes even the scarcer Organic Variety). My god, the humanity! How dare they? The Nazis live among us. Be afraid – very afraid. They may come for you next.

  • Jack

    Great Skatz! Let’s make sure everyone has EVERYTHING (entitlement programs). Who exactly is going to pay for this? Are you? Let’s face the truth…..resource is limited and will be rationed (already is) around the world. That’s how most countries keep healthcare cost down.
    Please don’t use scare tactics for your argument. Be realistic of the future. If we don’t conserve now our children and grandchildren won’t have a future.

    • skatz

      It’s a slippery slope, jack and you know it. I don’t argue everything for everyone – but where do you stop? And – do you apply the same rules to everyone – or, as is most likely the case – do you reserve special status for yourself? yeah – I thought so.

      I personally believe you can’t impose this on anyone – the best you can hope for is to educate, educate, educate – but wait – that might mean providing resources to the undeserving.

      • Jack

        Completely ignoring the inevitable is the problem. Slippery slope needs to be address instead of ignored like we been doing with medicare and social security.

        You apply basic rules to everyone and if you have the ability to go above and beyond then go for it. It’s no different than going to college. Some kids will need to stay in state instead of going to another school which will cost more. We make choices everyday. Medicine is no different.

        We educate plenty. People don’t listen. People need to take responsibility instead of hand outs. People need to make better choices. It’s like people choose to eat/live unhealthy life styles. People still immigrate to this country to make something out of themselves.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    The role of medicine is to lay out the options and the facts to the extent that those are known. Some patients will choose to fight against all odds, others won’t bother at all and most will fall somewhere in between.
    Patient-centered care means that patients have the freedom to make these decisions. Freedom is expensive when universally available. We have lots of other freedoms and liberties that are equally, if not more, expensive. Should we cut some corners and apply some restrictions there too?

  • Muddy Waters

    Margalit,

    The answer to your question is yes, we should.

    • skatz

      Are you suggesting we throw out the Constitution? A revolution? Forget the principles upon which our nation was founded? How very, very Un-American of you.

  • Doc99

    Recent paraphrase of Thatcher – The trouble with Socialism is that you eventually run out of other people’s Peas.

  • DrDutch

    <>

    1. Being a *doctor* does not afford a lucrative lifestyle. The cost is hundreds of thousands of dollars, and a lot of years. Fiscally, it would be more sound to choose a different profession. As lawmakers continue to toy with the notion of cutting reimbursement from medicare/-iad back further, the earning potential continues to dwindle, and the cost of the education continues to grow. It is getting harder to continue to mentor high school and college students who express a desire to have a career in this profession, mostly because of the overall cost. And while I’d be honored for any of my children to choose this career, I hope they consider something else. As it stands now, most of us will be fortunate to have our education debt paid off before our grandchildren in grammar school.

    2. Being *in* the profession doesn’t automatically result in easy access to care. We still have to wait for visits. We still have to pay for our insurance. While *professional courtesy* exists, I see it less and less with every passing year.

    3. The only thing that being in this profession does provide is an understanding of disease…..go ask a group of nurses or doctors if they have considered having the tattoo “DNR” on their chest.

    The cost of medicine is very high- and it continues to grow. To think that the aging population is NOT going to add to that cost is naive. And we as a medical community do not help matters when we continue to do the proverbial *full court press* when the end is inevitable. The dilemma is often getting families to understand and agree with recommendations. And as a physician who has walked many parents down that road, it is not easy. Because saying good-bye is damned hard.

  • Anonymous

    This is a really interesting conversation and typical, I think, of the debate that is taking place in the US about healthcare. What are we debating? What is the objective? I don’t see people in this thread or in the conversation at large speaking to the same issues or objectives.

    Let’s imagine the objective is care and compassion for all, which I believe echoes “life, liberty, and the pursuit of happiness”. Ok, we’re financially broke. Now what do we do? Let’s admit that the system is no longer working for us and rebuild it. I hope we build a system that is not driven by the needs of stockholders. Instead, we need a system that is driven by the needs of the stakeholders.

    Stakeholders include those not yet here, our grandchildren. Stakeholders include nursing aides who work for minimum wage. Stakeholders include the 50 million family caregivers who take care of someone they love. We must build a system that is sustainable, equitable, and just. If we fail, there will be great suffering.

  • markshea

    This is a really interesting conversation and typical, I think, of the debate that is taking place in the US about healthcare. What are we debating? What is the objective? I don’t see people in this thread or in the conversation at large speaking to the same issues or objectives.

    Let’s imagine the objective is care and compassion for all, which I believe echoes “life, liberty, and the pursuit of happiness”. Ok, we’re financially broke. Now what do we do? Let’s admit that the system is no longer working for us and rebuild it. I hope we build a system that is not driven by the needs of stockholders. Instead, we need a system that is driven by the needs of the stakeholders.

    Stakeholders include those not yet here, our grandchildren. Stakeholders include nursing aides who work for minimum wage. Stakeholders include the 50 million family caregivers who take care of someone they love. We must build a system that is sustainable, equitable, and just. If we fail, there will be great suffering.

  • Anonymous

    YES – I  too believe anyone everyone over age of 50 MUST have an Advance Directive.  It doesn’t take a lawyer or a doctor to do it.  It needs a lot of public health marketing – maybe a merit type job - for nurses, social workers etc  – creating excellent programs, with excellent communication, knoweldge about end-of-life issuess, small groups say, in senior centers,, personal and discrete, hands on - NOT lecturing.  Who will pay these workers?  Well, perhaps it could be a shared effort – some from communities, some from Big Gov as part decreasing end of life costs and some from the attendee.   5 WISHES advanced directive is legal in 42 states and online.  Workshops I have been to have not inticed me or really helped me to do this.  And no I wouldn;t ask my physician, don’t need to, I know what I want.